***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND The primary aim of the present study was to determine the dose of alfentanil that must be added to a rapid-sequence induction ( RSI ) regimen using thiopentone and rocuronium to obtain optimal intubation conditions in > 95 % of the individuals . METHODS A total of 60 ASA I patients were r and omly allocated to five different alfentanil dose groups ( 0 , 15 , 30 , 45 , or 60 microg kg-1 ) . A blinded dose of alfentanil followed by thiopentone 4 mg kg-1 and rocuronium 1 mg kg-1 was administered in rapid succession , and tracheal intubation was attempted 40 s thereafter . The relationship between the alfentanil dose and the probability of optimal intubation conditions was determined by non-linear logistic regression analysis . Blood pressure ( BP ) changes were recorded continuously using an intra-arterial catheter . RESULTS The success rate of optimal intubation conditions increased with increasing doses of alfentanil . The alfentanil dose needed to obtain optimal intubation conditions in > 95 % of the patients was 36.4 ( CI 33.4 - 39.4 ) microg kg-1 . In 12 patients , the systolic BP declined to < 90 mm Hg during the 3 min immediately after intubation . CONCLUSION Adding 36 - 40 microg kg-1 alfentanil to a regimen of thiopentone and rocuronium during RSI of anaesthesia may significantly increase the success rate of optimal intubation conditions . Significant hypotension requiring vasopressor treatment may occur Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more In three groups of 20 patients , anaesthetized with propofol and alfentanil , tracheal intubation conditions and the onset of neuromuscular blockade after administration of three different doses of mivacurium chloride ( 0.11 , 0.15 , and 0.19 mg/kg=1.5 × ED95 2. × ED95 , and 2.5 × ED95 ) were assessed . Intubation conditions were found to be clinical ly acceptable ( good or excellent ) in 83 % of patients . Eighty‐two per cent of patients were successfully intubated on the first attempt after 60–90 s. No difference in intubation scores or number of intubation attempts among the three dosage groups were found . We conclude that mivacurium chloride allows smooth intubation in most patients within 60 90 s , even with the lowest dose ( 0.11 mg/kg ) , after a propofol‐alfentanil induction of anaesthesia . However , because there were a few patients in whom intubating conditions were inadequate at 60–90 s , we are reluctant to advocate the preference of mivacurium chloride over suxamethonium for rapid sequence induction in emergency situations OBJECTIVE To compare the clinical conditions for intubation and neuromuscular parameters after a high dose of mivacurium ( 0.25 mg/kg ; 3 x SD95 ) administered in 30 s to those obtained after use of the usual dose of succinylcholine ( 1 mg/kg ) . PATIENTS AND METHODS Eighty-two patients , 37 in the succinylcholine group and 45 in the mivacurium group , were studied . Intubating conditions were assessed on a scale of 3 to 12 points analyzing ease of laryngoscopy , relaxation of vocal cords and presence of cough 60 seconds after administration of the drug . Neuromuscular parameters were acceleration of the thumb induced by supramaximal train-of-four stimulation of the cubital nerve . Heart rate and non-invasive mean blood pressure were recorded throughout surgery . Cutaneous flush was looked for after administration of the relaxant . RESULTS Time to onset of effect ( 159 s versus 82 s ) and times to recovery after mivacurium were significantly longer than with succinylcholine . Mivacurium afforded excellent/good conditions for intubation in 95.6 % of cases , with a neuromuscular blockade at intubation of 52.68 % . No significant hemodynamic changes or side effects were observed . CONCLUSIONS Given the moderate conditions of intubation achieved at 60 s , mivacurium can not be recommended as a relaxant in situations that require a rapid induction sequence . In elective surgery , 0.25 mg/kg of mivacurium can , however , be considered an alternative to succinylcholine Purpose To compare equi-lasting doses of a short-acting ( mivacurium ) to an intermediate-acting ( rocuronium ) neuromuscular relaxant , with regard to intubating conditions , efficacy , number of maintenance doses , hemodynamic alterations , adverse events and costs , in patients undergoing laparoscopic gynecological surgery . Methods Sixty patients were r and omly allocated to receive either 0.2 mg·kg−1 ( 3 × ED95 ) mivacurium or 0.5 mg·kg−1 ( 1.7 × ED95 ) rocuronium , under propofol/fentanyl anesthesia .  TI , first twitch of the train-of-four ( TOF ) and TOF ratio ( T4:TI ) were used to evaluate neuromuscular block using the Relaxometer ® mechanomyograph . The trachea was intubated when TI was maximally suppressed . Neuromuscular block was maintained at 25 % TI with equi-lasting doses of 0.075 mg·kg−1 mivacurium or 0 . 15 mg·kg−1 rocuronium . Results Mean ( min ) ± SD mivacurium onset time ( 1.9 ± 0.4 ) was longer than that of rocuronium ( 1.3 ± 0.3 ) . This did not yield a statistical difference in intubating conditions between the two groups . Interval 25–75 % TI recovery and time to 0.8 TOF recovery were prolonged following rocuronium ( 11.9 ± 3.9 , 52.6 ± 15.5 respectively ) compared to mivacurium ( 6.7 ± 2.3 , 39.2 ± 8 . 1 respectively ) . More patients , 22/30 , required mivacurium maintenance doses compared to 14/30 patients in the rocuronium group . Arterial blood pressure declined and 13/30 patients manifested erythema following mivacurium administration . The acquisition costs of rocuronium ( 6.93 Euro/patient ) were 23 % lower compared to mivacurium ( 8.96 Euro/patient ) . Conclusion Equi-lasting doses of rocuronium result ed in favourable intubating conditions more rapidly , improved hemodynamic stability , required less frequent administration of maintenance doses and were not associated with erythema , compared to mivacurium . RésuméObjectifComparer des doses de durée équivalente d’un myorelaxant à action brève , le mivacurium à celles d’un myorelaxant à effet intermédiaire , le rocuronium , quant aux conditions de l’intubation , l’efficacité , le nombre de doses de maintien , les changements hémodynamiques , les incidents et le coût , chez des patientes qui subissent une laparoscopie gynécologique . MéthodeSoixante patientes ont été réparties au hasard et ont reçu , soit 0,2 mg·kg−1 ( 3 × ED95 ) de mivacurium , soit 0,5 mg·kg−1 ( 1,7 × ED95 ) de rocuronium , sous une anesthésie au propofol et au fentanyl . TI , première stimulation d’un train-de-quatre ( TDQ ) et le ratio du TDQ ( T4 : TI ) ont permis d’évaluer la curarisation avec un relaxomécanomyographe . L’intubation a été réalisée après la suppression maximale de TI . La curarisation a été maintenue à 25 % de TI par des doses de durée équivalente de 0,075 mg·kg−1 de mivacurium ou de 0,15 mg·kg−1 de rocuronium . RésultatsLe délai d’installation moyen ( min ) [ ± l’écart type ] du mivacurium ( 1,9 ± 0,4 ) a été plus long que celui du rocuronium ( 1,3 ± 0,3 ) . Ce résultat ne fournit pas de différence statistique intergroupe . La récupération dans l’intervalle 25–75 % TI et le temps nécessaire à la récupération à 0,8 du TDQ se sont prolongés avec le rocuronium ( 11,9 ± 3,9 , 52,6 ± 15,5 respectivement ) comparé au mivacurium ( 6,7 ± 2,3 , 39,2 ± 8,1 respectivement ) . Un plus gr and nombre de patientes , 22/30 , ont eu besoin de doses de maintien de mivacurium , comparativement à 14/30 patientes ayant reçu du rocuronium . La tension artérielle a baissé et 13/30 patientes ontmanifesté de l’érythème à la suite de l’administration de mivacurium . Le coût d’achat du rocuronium ( 6,93 Euros/patiente ) a été de 23 % plus bas que celui du mivacurium ( 8,96 Euros/patiente ) . Conclusion Des doses de durée équivalente de rocuronium , comparé au mivacurium , ont permis une intubation plus précoce , amélioré la stabilité hémodynamique , exigé des doses de maintien moins fréquentes et n’ont pas été associées à un érythème We have studied the effects of mivacurium after induction of anaesthesia with alfentanil-propofol in healthy adult oral surgical patients . Anaesthesia was maintained with nitrous oxide and 0.75 % ( end-tidal ) enflurane in oxygen after nasotracheal intubation . Recordings were made of the rectified compound adductor pollicis electromyogram in response to train-of-four ( TOF ) ulnar nerve stimulation . First and fourth TOF responses were defined as T1 and T4 , with T1 suppression referenced to pre-mivacurium T1 height ( Tc ) . Onset times ( mean ( SEM ] to 90 % T1 suppression were 2.5 ( 0.2 ) , 2.1 ( 0.3 ) and 1.6 ( 0.1 ) min , respectively , after mivacurium 0.15 mg kg-1 ( n = 18 ) and 0.2 mg kg-1 ( n = 18 ) as 5-s boluses and 0.2 mg kg-1 over 30 s ( n = 9 ) . Intubating conditions 2 min after 0.15 mg kg-1 were good to excellent and not improved by a further 30-s delay or by use of a 0.2-mg kg-1 dose . Recovery to T1/Tc of 5 % occurred on average in 12 - 13 min irrespective of dose . Thereafter , mivacurium infusions commenced at 8 - 10 micrograms kg-1 min-1 were adjusted at intervals of at least 3 min to achieve T1/Tc in the range 1 - 10 % . Mean duration of infusion was 58 ( 3.4 ) min and mean infusion rate after a 15-min stabilization period was 6.6 ( range 2.3 - 12.9 ) micrograms kg-1 min-1 . On cessation of infusions , spontaneous recovery from T1/Tc 8 % ( 1.0 % ) to T4:T1 = 0.7 took 17 ( 1.2 ) min . Neostigmine 0.04 mg kg-1 or edrophonium 0.75 mg kg-1 evoked recovery from T1/Tc 9 % ( SEM 1.2 % and 1.0 % , respectively ) to T4:T1 = 0.7 in 11 ( 0.6 ) and 8 ( 0.9 ) min ( both P less than 0.001 vs spontaneous recovery ) We have studied the effects of mivacurium after induction of anesthesia with fentanyl-propofol in healthy adult women . Anesthesia was maintained with nitrous oxide in oxygen and continuous infusion of propofol ( 6 - 10 mg/kg/hr . ) . A myorelaxograph ( Date x NMT 100 ) measuring the responses of the adductor pollicis to Train of Four ( TOF ) stimulations of the ulnar nerve was installed after induction . Three bolus dosages of mivacurium were administered just after induction : 0.15 mg/kg ( group A ) , 0.17 mg/kg ( group B ) and 0.19 mg/kg ( group C ) . Intubation was attempted at 75 % TI-suppression . The conditions of intubation were good to excellent in the three groups except for one patient in group A ( 0.15 mg/kg ) . Successful intubation was performed faster in group C(p = 0.017 ) 
    Output:
    
We conclude that good conditions for tracheal intubation are more likely by delaying laryngoscopy after injecting a higher dose of mivacurium with an opioid , particularly in older people