human
***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Intrathecal adjutants can be used for regional anesthesia ( RA ) in cesarean section to improve its quality in terms of time and complications . Some previous studies focused on the effects of adding sufentanil and /or midazolam to bupivacaine and compared each with using bupivacaine alone . However , there has been no study to assess the effects of using sufentanil and midazolam in combination with bupivacaine . Objectives : The aim of this study was to evaluate and compare properties ( time of achievement/recovery of sensory/motor blocks ; and time to request opium ) , complications ( nausea , vomiting , shivering and hypotension ) , and neonatal first minute Apgar score with and without the addition of midazolam ( M ) or sufentanil ( S ) to bupivacaine ( B ) through intrathecal injection for spinal anesthesia , after the cesarean section . Patients and Methods : In this double blind r and omized clinical trial participants were r and omly allocated to three equal groups : Group B ( 2.5 cc of bupivacaine 0.5 % + 1 cc normal saline 0.9 % ) , Group BM ( 2.5 cc of bupivacaine + 0.02 mg/kg midazolam ) and Group BS ( 2.5 cc of bupivacaine 0.5 % + 0.7 cc normal saline 0.9 % + 1.5 µg of sufentanil , 0.3 cc ) . We used analysis of variance ( ANOVA ) , post hoc test with Bonferroni adjustment , and chi-square test for statistical analysis ; the analyses were performed using the SPSS-16 software . Given a significant level of 0.05 , overall and pair-wise comparisons were made . Results : Seventy-five females participated in the study with no significant age difference ( mean ± st and ard deviation ( SD ) : 28.60 ± 6.06 , 28.12 ± 5.29 and 28.76 ± 3.97 year ; P = 0.9 ) . Except for “ time to motor block recovery ” ( P = 0.057 ) , the overall differences among the three groups was significant in terms of “ time to sensory/motor block ” ( P < 0.001 ) , “ time to sensory block recovery ” ( P < 0.001 ) , and “ time to request opium ” ( P < 0.001 ) . In all pair-wise comparisons there was no significant difference between the BM and BS group , except for “ time to request opium ” , which was longer in the BS group ( P < 0.001 ) . The occurrence of nausea ( P = 0.02 ) , postoperative shivering ( P = 0.01 ) and hypotension ( P < 0.001 ) were significantly different between the groups , unlike vomiting , where the difference was not significant ( P = 0.2 ) . All neonates had an Apgar score of nine . Conclusions : The findings showed that adding sufentanil or midazolam to bupivacaine shortens the onset of spinal anesthesia and increases the time duration of anesthesia ; however it does not change the motor block recovery time . Adding sufentanil delays the first request for narcotic analgesics while adding midazolam leads to a decrease in nausea and hypotension . Adding sufentanil or midazolam does not have any deleterious effect on infants ’ Apgar scores . However , increases shivering in patients Background Shivering related to spinal anesthesia may interfere with monitoring and is uncomfortable . The aim of the present study was to investigate low-dose intrathecal meperidine for the prevention of shivering after induction of spinal anesthesia in parturients with cesarean section . Methods This was a prospect i ve r and omized , double-blind , placebo-controlled trial including 100 parturients , of American Society of Anesthesiologists ( ASA ) physical status I or II , scheduled for elective cesarean section under spinal anesthesia who were r and omly assigned to a meperidine ( 0.2 mg/kg ) plus hyperbaric lidocaine ( 5 % , 75 mg , n = 50 ; group M ) group or a placebo plus hyperbaric lidocaine ( 5 % , 75 mg , n = 50 ; group L ) group . Demographic and surgical data , adverse events , and the mean intensity for each parturient were assessed during the entire study period by a blinded observer . Results There were no significant differences between the two study groups regarding the demographic and surgical data ( P > 0.05 ) . The incidence of shivering during the entire study period significantly decreased in the group of parturients who received intrathecal meperidine ( P = 0.04 ) . There were no significant differences in nausea and vomiting between the two groups . Conclusions Low-dose intrathecal meperidine ( 10 mg ) is safe and effective in reducing the incidence and severity of shivering associated with spinal anesthesia in parturients with cesarean section Shivering associated with spinal anesthesia during Cesarean delivery is an uncomfortable experience for the parturient , which may also cause adverse effects . In this prospect i ve , r and omized , double-blind , placebo-controlled study , we sought to evaluate the effect of intrathecal dexmedetomidine , administered as an adjunct to hyperbaric bupivacaine for Cesarean delivery , on the incidence and severity of shivering associated with spinal anesthesia . Patients undergoing Cesarean delivery were r and omly allocated to three groups of 30 patients each . Experimental treatments were added to hyperbaric bupivacaine as follows : Patients in group I ( control ) were administered isotonic saline . Patients in groups II and III received dexmedetomidine ( 2.5 , 5 µg , respectively ) , mixed with isotonic saline . Shivering was observed in 11 , 10 and 2 patients in groups I , II and III , respectively . The incidence of shivering in group III was significantly lower than that in groups I ( p=0.005 ) and II ( p=0.01 ) . The severity of shivering was significantly different between the three groups ( p=0.01 ) . There were no significant inter-group differences with respect to mean arterial pressure and heart rate at any time point after administration of intrathecal local anesthesia ( p>0.05 ) . Intrathecal dexmedetomidine ( 5 µg ) administered as an adjunct to hyperbaric bupivacaine during Cesarean delivery significantly reduced the incidence and intensity of shivering associated with spinal anesthesia Background : Shivering , the rate of which in regional anesthesia is 39 % is an undesired complication seen postoperatively . Aims : This study aims to compare the ability of preventing the shivering of preemptive tramadol and dexmedetomidine during the spinal anesthesia ( SA ) . Methods : A total of 90 patients with American Society of Anesthesiologists physical status I-II , aged 18 - 60 years and undergoing elective arthroscopic surgery with SA were divided into three groups r and omly . After spinal block , 100 mg tramadol in 100 ml saline was applied in group T- ( n = 30 ) and 0.5 μg/kg dexmedetomidine in 100 ml saline was applied in group D- ( n = 30 ) and 100 ml saline was administered in group P- ( n = 30 ) in 10 min . The hemodynamics , oxygen saturation , tympanic temperature , shivering and sedation scores were evaluated and recorded intraoperatively and 45 min after a postoperative period . Results : In group T and D , shivering scores were significantly lower when compared with group P in the intraoperative 20th min ( P = 0.01 ) . Sedation scores in group D were significantly higher than the baseline values ( P = 0.03 ) and values in group T and P ( P = 0.04 ) . Conclusions : Preemptive tramadol and dexmedetomidine are effective in preventing the shivering under SA . In addition , dexmedetomidine was superior in increasing the level of sedation which is sufficient to prevent the anxiety without any adverse effects BACKGROUND Intrathecal tramadol combined with local anaesthetics has been used for postoperative analgesia following lower abdominal and perineal surgery . The present study evaluated the effect of intrathecal tramadol on spinal block characteristics and neonatal outcome after elective caesarean section . METHODS Eighty full-term parturients scheduled for elective caesarean section were r and omly divided into two groups . In the fentanyl group , patients received intrathecal 0.5 % bupivacaine 10 mg with fentanyl 10 μg ; in the tramadol group , patients were given the same dose of bupivacaine with tramadol 10 mg  . Sensory and motor block characteristics , duration of postoperative analgesia , maternal side effects , and neonatal outcome were compared . RESULTS One patient in the tramadol group and two patients in the fentanyl group were excluded from data analysis . Median [ interquartile range ] duration of postoperative analgesia in the tramadol and the fentanyl groups was 300 [ 240 - 360 ] min and 260 [ 233 - 300 ] min respectively ( P = 0.02 ) . The incidence of shivering was lower in patients who received tramadol ( 5 % ) than those who had fentanyl ( 32 % ) ( P = 0.003 ) . Apgar scores , umbilical cord acid-base measurement and neurologic and adaptive capacity scores were comparable between the two groups . CONCLUSION Compared to intrathecal fentanyl 10 μg , tramadol 10 mg , as an adjunct to bupivacaine for subarachnoid block for caesarean section , showed a longer duration of analgesia with a reduced incidence of shivering We performed a prospect i ve , r and omised , double blind study to compare the antishivering effect of morphine and pethidine when added to intrathecal hyperbaric bupivacaine during elective Caesarean delivery under combined‐spinal epidural anaesthesia . Spinal anaesthesia consisted of either 8–10 mg of 0.5 % bupivacaine alone  ( group B ; n = 30 ) with 0.1 mg morphine ( group BM0.1 ; n = 29 ) , with 0.2 mg morphine ( group BM0.2 ; n = 30 ) , or with 10 mg pethidine ( group BPeth10 ; n = 30 ) . The incidences of shivering were 23.3 % ( 7/30 ) in group B , 17 % ( 5/29 ) in group BM0.1 , 13.3 % ( 4/30 ) in group BM0.2 and 3.3 % ( 1/30 ) in group BPeth10 ( p < 0.05 ) . The shivering intensity for each patient was significantly higher in group B than the other groups . In conclusion , intrathecal pethidine added to hyperbaric bupivacaine  reduces the incidence and intensity of shivering more than does morphine ( 0.1 or 0.2 mg ) BACKGROUND AND OBJECTIVES Shivering is a cause of discomfort and dissatisfaction in patients undergoing cesarean section . The objective of this study paper was to assess the impact of intrathecal administration of sufentanil on the incidence of shivering after cesarean section . METHOD In a prospect i ve blinded , r and omized clinical trial , pregnant women undergoing cesarean section under spinal anesthesia were enrolled . Pregnant women in labor , febrile , obese , with pregnancy-induced hypertension , anesthetic block failure or surgical complications were excluded . Patients were r and omly assigned to two groups . In Group I , 10 mg of 0.5 % hyperbaric bupivacaine combined with 80 mcg of morphine and 2.5 mcg of sufentanil were administered . In Group II , 10 mg of 0.5 % hyperbaric bupivacaine combined with 80 mcg of morphine were administered . In the post-anesthesia care unit , patients were evaluated for signs of shivering by an investigator blinded to the patient 's group allocation . RESULTS The sample consisted of 80 patients . In both groups there was a decrease in axillary temperature of patients after cesarean section ( p<0.001 ) . This decrease was not different between groups ( p<0.21 ) . In Group I , the incidence of tremor was 32.5 % ( 13/40 ) and in Group II it was 62.5 % ( 25/40 ) ( p<0.007 ) ; RR 0.53 ( CI 95 % 0.32 - 0.87 ) . CONCLUSIONS It has been suggested that the addition of sufentanil to hyperbaric bupivacaine and morphine during spinal anesthesia for cesarean section provides a decrease in the incidence of shivering in the immediate postoperative period Background and Objectives . Fentanyl at doses of 6.25 μg or more , when added to hyperbaric bupivacaine for spinal anesthesia for cesarean delivery , has been reported to markedly increase the duration of analgesia . In this study , subarachnoid fentanyl 15 μg was evaluated as the sole adjunct to hyper 
    Output:
    
agent
The results showed that , compared with placebo , pethidine , fentanyl , dexmedetomidine , and sufentanil significantly reduced the incidence of perioperative shivering .
In addition , compared with sufentanil , fentanyl showed no impact on haemodynamic stability and the incidence of pruritus .
CONCLUSION Pethidine , fentanyl , dexmedetomidine , and sufentanil appear to be effective for preventing perioperative shivering in puerperae undergoing cesarean sections .
Considering the risk-benefit profiles of the included neuraxial adjuvants , fentanyl is probably the optimal choice
***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Intrathecal adjutants can be used for regional anesthesia ( RA ) in cesarean section to improve its quality in terms of time and complications . Some previous studies focused on the effects of adding sufentanil and /or midazolam to bupivacaine and compared each with using bupivacaine alone . However , there has been no study to assess the effects of using sufentanil and midazolam in combination with bupivacaine . Objectives : The aim of this study was to evaluate and compare properties ( time of achievement/recovery of sensory/motor blocks ; and time to request opium ) , complications ( nausea , vomiting , shivering and hypotension ) , and neonatal first minute Apgar score with and without the addition of midazolam ( M ) or sufentanil ( S ) to bupivacaine ( B ) through intrathecal injection for spinal anesthesia , after the cesarean section . Patients and Methods : In this double blind r and omized clinical trial participants were r and omly allocated to three equal groups : Group B ( 2.5 cc of bupivacaine 0.5 % + 1 cc normal saline 0.9 % ) , Group BM ( 2.5 cc of bupivacaine + 0.02 mg/kg midazolam ) and Group BS ( 2.5 cc of bupivacaine 0.5 % + 0.7 cc normal saline 0.9 % + 1.5 µg of sufentanil , 0.3 cc ) . We used analysis of variance ( ANOVA ) , post hoc test with Bonferroni adjustment , and chi-square test for statistical analysis ; the analyses were performed using the SPSS-16 software . Given a significant level of 0.05 , overall and pair-wise comparisons were made . Results : Seventy-five females participated in the study with no significant age difference ( mean ± st and ard deviation ( SD ) : 28.60 ± 6.06 , 28.12 ± 5.29 and 28.76 ± 3.97 year ; P = 0.9 ) . Except for “ time to motor block recovery ” ( P = 0.057 ) , the overall differences among the three groups was significant in terms of “ time to sensory/motor block ” ( P < 0.001 ) , “ time to sensory block recovery ” ( P < 0.001 ) , and “ time to request opium ” ( P < 0.001 ) . In all pair-wise comparisons there was no significant difference between the BM and BS group , except for “ time to request opium ” , which was longer in the BS group ( P < 0.001 ) . The occurrence of nausea ( P = 0.02 ) , postoperative shivering ( P = 0.01 ) and hypotension ( P < 0.001 ) were significantly different between the groups , unlike vomiting , where the difference was not significant ( P = 0.2 ) . All neonates had an Apgar score of nine . Conclusions : The findings showed that adding sufentanil or midazolam to bupivacaine shortens the onset of spinal anesthesia and increases the time duration of anesthesia ; however it does not change the motor block recovery time . Adding sufentanil delays the first request for narcotic analgesics while adding midazolam leads to a decrease in nausea and hypotension . Adding sufentanil or midazolam does not have any deleterious effect on infants ’ Apgar scores . However , increases shivering in patients Background Shivering related to spinal anesthesia may interfere with monitoring and is uncomfortable . The aim of the present study was to investigate low-dose intrathecal meperidine for the prevention of shivering after induction of spinal anesthesia in parturients with cesarean section . Methods This was a prospect i ve r and omized , double-blind , placebo-controlled trial including 100 parturients , of American Society of Anesthesiologists ( ASA ) physical status I or II , scheduled for elective cesarean section under spinal anesthesia who were r and omly assigned to a meperidine ( 0.2 mg/kg ) plus hyperbaric lidocaine ( 5 % , 75 mg , n = 50 ; group M ) group or a placebo plus hyperbaric lidocaine ( 5 % , 75 mg , n = 50 ; group L ) group . Demographic and surgical data , adverse events , and the mean intensity for each parturient were assessed during the entire study period by a blinded observer . Results There were no significant differences between the two study groups regarding the demographic and surgical data ( P > 0.05 ) . The incidence of shivering during the entire study period significantly decreased in the group of parturients who received intrathecal meperidine ( P = 0.04 ) . There were no significant differences in nausea and vomiting between the two groups . Conclusions Low-dose intrathecal meperidine ( 10 mg ) is safe and effective in reducing the incidence and severity of shivering associated with spinal anesthesia in parturients with cesarean section Shivering associated with spinal anesthesia during Cesarean delivery is an uncomfortable experience for the parturient , which may also cause adverse effects . In this prospect i ve , r and omized , double-blind , placebo-controlled study , we sought to evaluate the effect of intrathecal dexmedetomidine , administered as an adjunct to hyperbaric bupivacaine for Cesarean delivery , on the incidence and severity of shivering associated with spinal anesthesia . Patients undergoing Cesarean delivery were r and omly allocated to three groups of 30 patients each . Experimental treatments were added to hyperbaric bupivacaine as follows : Patients in group I ( control ) were administered isotonic saline . Patients in groups II and III received dexmedetomidine ( 2.5 , 5 µg , respectively ) , mixed with isotonic saline . Shivering was observed in 11 , 10 and 2 patients in groups I , II and III , respectively . The incidence of shivering in group III was significantly lower than that in groups I ( p=0.005 ) and II ( p=0.01 ) . The severity of shivering was significantly different between the three groups ( p=0.01 ) . There were no significant inter-group differences with respect to mean arterial pressure and heart rate at any time point after administration of intrathecal local anesthesia ( p>0.05 ) . Intrathecal dexmedetomidine ( 5 µg ) administered as an adjunct to hyperbaric bupivacaine during Cesarean delivery significantly reduced the incidence and intensity of shivering associated with spinal anesthesia Background : Shivering , the rate of which in regional anesthesia is 39 % is an undesired complication seen postoperatively . Aims : This study aims to compare the ability of preventing the shivering of preemptive tramadol and dexmedetomidine during the spinal anesthesia ( SA ) . Methods : A total of 90 patients with American Society of Anesthesiologists physical status I-II , aged 18 - 60 years and undergoing elective arthroscopic surgery with SA were divided into three groups r and omly . After spinal block , 100 mg tramadol in 100 ml saline was applied in group T- ( n = 30 ) and 0.5 μg/kg dexmedetomidine in 100 ml saline was applied in group D- ( n = 30 ) and 100 ml saline was administered in group P- ( n = 30 ) in 10 min . The hemodynamics , oxygen saturation , tympanic temperature , shivering and sedation scores were evaluated and recorded intraoperatively and 45 min after a postoperative period . Results : In group T and D , shivering scores were significantly lower when compared with group P in the intraoperative 20th min ( P = 0.01 ) . Sedation scores in group D were significantly higher than the baseline values ( P = 0.03 ) and values in group T and P ( P = 0.04 ) . Conclusions : Preemptive tramadol and dexmedetomidine are effective in preventing the shivering under SA . In addition , dexmedetomidine was superior in increasing the level of sedation which is sufficient to prevent the anxiety without any adverse effects BACKGROUND Intrathecal tramadol combined with local anaesthetics has been used for postoperative analgesia following lower abdominal and perineal surgery . The present study evaluated the effect of intrathecal tramadol on spinal block characteristics and neonatal outcome after elective caesarean section . METHODS Eighty full-term parturients scheduled for elective caesarean section were r and omly divided into two groups . In the fentanyl group , patients received intrathecal 0.5 % bupivacaine 10 mg with fentanyl 10 μg ; in the tramadol group , patients were given the same dose of bupivacaine with tramadol 10 mg  . Sensory and motor block characteristics , duration of postoperative analgesia , maternal side effects , and neonatal outcome were compared . RESULTS One patient in the tramadol group and two patients in the fentanyl group were excluded from data analysis . Median [ interquartile range ] duration of postoperative analgesia in the tramadol and the fentanyl groups was 300 [ 240 - 360 ] min and 260 [ 233 - 300 ] min respectively ( P = 0.02 ) . The incidence of shivering was lower in patients who received tramadol ( 5 % ) than those who had fentanyl ( 32 % ) ( P = 0.003 ) . Apgar scores , umbilical cord acid-base measurement and neurologic and adaptive capacity scores were comparable between the two groups . CONCLUSION Compared to intrathecal fentanyl 10 μg , tramadol 10 mg , as an adjunct to bupivacaine for subarachnoid block for caesarean section , showed a longer duration of analgesia with a reduced incidence of shivering We performed a prospect i ve , r and omised , double blind study to compare the antishivering effect of morphine and pethidine when added to intrathecal hyperbaric bupivacaine during elective Caesarean delivery under combined‐spinal epidural anaesthesia . Spinal anaesthesia consisted of either 8–10 mg of 0.5 % bupivacaine alone  ( group B ; n = 30 ) with 0.1 mg morphine ( group BM0.1 ; n = 29 ) , with 0.2 mg morphine ( group BM0.2 ; n = 30 ) , or with 10 mg pethidine ( group BPeth10 ; n = 30 ) . The incidences of shivering were 23.3 % ( 7/30 ) in group B , 17 % ( 5/29 ) in group BM0.1 , 13.3 % ( 4/30 ) in group BM0.2 and 3.3 % ( 1/30 ) in group BPeth10 ( p < 0.05 ) . The shivering intensity for each patient was significantly higher in group B than the other groups . In conclusion , intrathecal pethidine added to hyperbaric bupivacaine  reduces the incidence and intensity of shivering more than does morphine ( 0.1 or 0.2 mg ) BACKGROUND AND OBJECTIVES Shivering is a cause of discomfort and dissatisfaction in patients undergoing cesarean section . The objective of this study paper was to assess the impact of intrathecal administration of sufentanil on the incidence of shivering after cesarean section . METHOD In a prospect i ve blinded , r and omized clinical trial , pregnant women undergoing cesarean section under spinal anesthesia were enrolled . Pregnant women in labor , febrile , obese , with pregnancy-induced hypertension , anesthetic block failure or surgical complications were excluded . Patients were r and omly assigned to two groups . In Group I , 10 mg of 0.5 % hyperbaric bupivacaine combined with 80 mcg of morphine and 2.5 mcg of sufentanil were administered . In Group II , 10 mg of 0.5 % hyperbaric bupivacaine combined with 80 mcg of morphine were administered . In the post-anesthesia care unit , patients were evaluated for signs of shivering by an investigator blinded to the patient 's group allocation . RESULTS The sample consisted of 80 patients . In both groups there was a decrease in axillary temperature of patients after cesarean section ( p<0.001 ) . This decrease was not different between groups ( p<0.21 ) . In Group I , the incidence of tremor was 32.5 % ( 13/40 ) and in Group II it was 62.5 % ( 25/40 ) ( p<0.007 ) ; RR 0.53 ( CI 95 % 0.32 - 0.87 ) . CONCLUSIONS It has been suggested that the addition of sufentanil to hyperbaric bupivacaine and morphine during spinal anesthesia for cesarean section provides a decrease in the incidence of shivering in the immediate postoperative period Background and Objectives . Fentanyl at doses of 6.25 μg or more , when added to hyperbaric bupivacaine for spinal anesthesia for cesarean delivery , has been reported to markedly increase the duration of analgesia . In this study , subarachnoid fentanyl 15 μg was evaluated as the sole adjunct to hyper 
    Output:
    