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 The French- Language Society of Paediatric Anaesthesiologists ( ADARPEF ) design ed a 1-year prospect i ve , multicenter and anonymous study to up date both epidemiology and morbidity of  regional anesthesia in children . METHODS From November 2005 to October 2006 , data from participating hospitals were recorded using an identification form , a data recording form , and a complication form . Information collected included the characteristics of the hospitals , the number and type of regional anesthetics ( RA ) , the age of the involved children as well as the incidence , and type of complications . RESULTS Data collected in 47 institutions included 104,612 pure general anesthesias ( GAs ) , 29,870 GAs associated with regional blocks , and 1262 pure regional blocks .  Central blocks accounted for 34 % of all RA . Peripheral blocks ( 66 % ) were upper or lower limb blocks ( 29 % of peripheral blocks ) , trunk blocks , and face blocks ( 71 % ) . In children aged ≤3 years , the percentage of central blocks was similar to the peripheral ones ( 45 % vs 55 ) , while in older children , peripheral blocks were more than four times used than central ones . Complications ( 41 involving 40 patients ) were rare and usually minor . They did not result in any sequelae . The study revealed an overall rate of complication of 0.12 % ; CI 95 % [ 0.09 - 0.17 ] , significantly six times higher for central than for peripheral blocks . CONCLUSIONS As a result of the low rate of complications , RA techniques have a good safety profile and can be used to provide postoperative analgesia . In addition , the results should encourage anesthesiologists to continue to use peripheral instead of central ( including caudal ) blocks as often as possible when appropriate PURPOSE : Colorectal surgery is associated with postoperative ileus , which contributes to delayed discharge . This study was design ed to investigate the effect of thoracic epidural anesthesia and analgesia on gastrointestinal function after colorectal surgery under st and ardized controlled postoperative care . METHODS : Forty-two patients diagnosed with either colonic cancer , diverticulitis , polyps , or adenoma , and scheduled for elective colorectal surgery , were r and omly assigned to either postoperative patient-controlled analgesia ( PCA ) with intravenous morphine ( n=21 ) or epidural analgesia with a mixture of bupivacaine and fentanyl ( n=21 ) . Postoperative early oral feeding and assistance to mobilization were offered to all patients . Pain visual analog scale ( 1–100 mm ) , passage of flatus and bowel movements , length of hospital stay , and readiness for discharge were recorded . RESULTS : Pain visual analog scale ( visual analog scale , 1–100 mm ) at rest , on coughing , and daily on mobilization was significantly lower in the epidural group compared with the patient-controlled analgesia group . Median values for the visual analog scale group were 7 ( 95 percent confidence interval , 2–18 ) mm , 19 ( 95 percent confidence interval , 4–38 ) mm , and 10 ( 95 percent confidence interval , 5–33 ) mm , respectively , and , for the patient-controlled analgesia group , were 24 ( 95 percent confidence interval , 18–51 ) mm , 59 ( 95 percent confidence interval , 33–74 ) mm , and 40 ( 95 percent confidence interval , 29–79 ) mm , respectively ( P<0.01 ) . Intake of protein and calories and time out of bed were similar in both groups . Mean time intervals ± st and ard deviation from surgery to first flatus and first bowel movement occurred earlier in the epidural group , 1.9±0.6 days and 3.1±1.7 days , respectively , compared with patient-controlled analgesia , 3.6±1.5 days and 4.6 ± 1.6 days , respectively ( P<0.01 ) . Postoperative complications occurred in 33 percent of the patient-controlled analgesia group and 28 percent of the epidural group . There was no significant difference in length of hospital stay between the two groups with a mean of 7.3±3.7 days in the patient-controlled analgesia group and 8.5±4.2 days in the epidural group . Readiness for discharge was similar in both groups . CONCLUSION : Thoracic epidural analgesia has distinct advantages over patient-controlled analgesia morphine in providing superior quality of analgesia and shortening the duration of postoperative ileus . However , discharge home was not faster , indicating that other perioperative factors influence the length of hospital stay UNLABELLED Anesthetic methods used during cesarean section have advantages and disadvantages to both mothers and infants and may result in short and long term neonatal effects . OBJECTIVE To determine the effects of general and regional anesthesia on the infants , a prospect i ve , r and omized trial was performed in Siriraj Hospital , Mahidol University . MATERIAL AND METHOD 341 uncomplicated pregnant women who were to be delivered at term by Cesarean section were recruited and r and omized to receive general anesthesia , GA ( 103 ) ; epidural anesthesia , EA ( 120 ) and spinal anesthesia , SA ( 118 ) . The immediate fetal and neonatal effects were assessed by cord blood gas analysis and the infant 's Apgar scores . The Neurologic and Adaptive Capacity Scores ( NACS ) was performed within 4 hours after birth by two pediatricians who were blind to the anesthetic method . RESULT Maternal age , weight , height , duration of the operation and infants ' birth weight were not different among the study groups . In the EA and SA group , maternal systolic blood pressure decreased more than 20 per cent from the baseline in more than half . The infants ' Apgar scores at 1 and 5 minutes were 8.3 + /- 1.9 ; 8.2 + /- 1.6 ; 6.7 + /- 2.8 , and 9.7 + /- 0.9 ; 9.8 + /- 0.7 ; 9.2 + /- 1.6 in EA , SA and GA group respectively . The adaptive capacity , active tone , passive tone , general assessment and primary reflexes of the NACS were not statistically different . CONCLUSION Apgar scores of the infants whose mothers received general anesthesia were lower than infants whose mothers received regional anesthesia but the NACS were not statistically different among the three study groups The actual incidence of neurologic dysfunction result ing from hemorrhagic complications associated with neuraxial blockade is unknown . Although the incidence cited in the literature is estimated to be less than 1 in 150,000 epidural and less than 1 in 220,000 spinal anesthetics , recent epidemiologic surveys suggest that the frequency is increasing and may be as high as 1 in 3000 in some patient population s. Overall , the risk of clinical ly significant bleeding increase with age , associated abnormalities of the spinal cord or vertebral column , the presence of an underlying coagulopathy , difficulty during needle placement , and an indwelling neuraxial catheter during sustained anticoagulation ( particularly with st and ard heparin or low-molecular weight heparin ) . The need for prompt diagnosis and intervention to optimize is also consistently reported . In response to these patient safety issues , the American Society of Regional Anesthesia and Pain Medicine ( ASRA ) convened its Third Consensus Conference on Regional Anesthesia and Anticoagulation . Practice guidelines or recommendations summarize evidence -based review s. However , the rarity of spinal hematoma defies a prospect i ve r and omized study , and there is no current laboratory model . As a result , the ASRA consensus statements represent the collective experience of recognized experts in the field of neuraxial anesthesia and anticoagulation . These are based on case reports , clinical series , pharmacology , hematology , and risk factors for surgical bleeding . An underst and ing of the complexity of this issue is essential to patient management Colonic surgery patients were studied to measure : the influence of continuous thoracic epidural analgesia ( TEA ) on a postoperative pain score , the time till onset of defaecation , blood loss , postoperative temperature elevations , rate of bacterial contamination of wounds and urine , and general surgical complications .  Group I patients ( n = 57 ) received general anaesthesia and TEA for the operation , followed by continuous TEA ( 0·25 per cent bupivacaine ) for 72 h.  Group II patients ( n = 59 ) received general anaesthesia for the operation , followed by systemic analgesia on request . Significant beneficial effects of TEA in group I were demonstrated by lower pain scores in the first 24 h after surgery and earlier defaecation . However , there were fewer temperature elevations in group II . There was no significant difference between the groups in terms of positive bacteriological cultures , blood loss , need for postoperative mechanical ventilation and complications . However , there was a trend toward a higher rate of rectal anastomotic breakdown , increased blood replacement and intensive care therapy , and longer hospitalization in group I. These results do not suggest any significant beneficial therapeutic effect of continuous TEA in colonic surgery compared with a conventional systemic analgesic regimen . In selected patients ( i.e. those with severe pain or those prone to develop postoperative ileus ) continuous TEA may be beneficial We have studied the effect of extradural analgesia on postoperative venous thrombosis in patients undergoing knee arthroplasty . Forty-eight patients were allocated r and omly to receive either general anaesthesia or extradural analgesia with local anaesthetics for 3 days . All patients wore compressive elastic stockings and no anticoagulant drugs were administered . Bilateral venography was performed 10 days after surgery . Continuous extradural analgesia did not impede mobilization of the patients . One case of nonfatal pulmonary embolism occurred in a patient who received general anaesthesia . The use of continuous extradural analgesia result ed in a significant difference in the total incidence of deep vein thrombosis ( 18 % compared with 59 % after general anaesthesia ( P = 0.02 ] . The incidence of calf vein thrombosis was 12 % compared with 45 % after general anaesthesia ( P = 0.05 ) Ninety healthy parturients undergoing elective caesarean section were r and omly allocated to receive either general ( n = 30 ) , epidural ( n = 30 ) or spinal ( n = 30 ) anaesthesia .  Acid-base status , Apgar score and neurobehavioural status , using the neurologic and adaptive capacity scoring ( NACS ) system , were studied in the newborn . Apgar scores and acid-base parameters were similar in all the three groups . NACS testing revealed significantly more vigorous babies in the spinal anaesthesia group than in the other two groups at 15 min and 2 h interval after delivery , despite a higher incidence of maternal hypotension . We conclude that newborns tend to have a better neurobehavioural status in the early post-delivery period if their mothers receive spinal anaesthesia rather than general or epidural anaesthesia for caesarean section Twenty-two patients undergoing upper abdominal surgery were entered into a r and omized , double-blind study to receive extradural ( T7-T8 ) 0.5 % bupivacaine 9 ml followed by 25 mg h-1 with or without additional extradural morphine ( bolus 4 mg plus 0.5 mg h-1 ) , for 16 h after operation . Addition of morphine was associated with total alleviation of pain , and a stable level of sensory analgesia , but not with changes in blood glucose and cortisol concentrations or postoperative impairment of lung function ( PEFR , FEV1 , FVC ) .  Two patients were withdrawn because of hypotension or respiratory depression The effects of thoracic epidural anesthesia ( TEA ) on total body oxygen supply-dem and ratio are complex due to potential influences on both O2 delivery ( & OV0422;O2 ) and consumption ( & OV0312;O2 ) . One hundred and five patients undergoing abdominal aortic surgery were r and omly assigned to one of three groups to compare the cardiovascular and metabolic responses associated with ( 1 ) thoracic epidural anesthesia plus light general anesthesia ( group TEA ) ; ( 2 ) general anesthesia with halothane ( group H ) ; and ( 3 ) neuroleptanalgesia ( group NLA ) . Values of cardiac index ( CI ) and & OV0422;O2 were less intra operatively in the TEA group than in the H or NLA groups , while & OV0312;O2 values were similar . & OV0312;O2 during recovery was greater in both the TEA and NLA groups than in the H group . Consequently the oxygen supply-dem and ratio ( & OV0422;O2/&OV0312;O2 ) was less in the TEA group throughout the perioperative period and about 30 % below baseline values during early recovery . At comparable & OV0312;O2 , CI and mixed venous O2 saturation were always less in the TEA group than in the NLA group . Heart rate was slowest intra operatively during TEA , and stroke work was less with TEA than with NLA . As cardiac filling pressure and systemic vascular resistance did not differ among the three groups , reduced adaptation of CI to t 
    Output:
    
agent
Compared with general anaesthesia , a central neuraxial block may reduce the zero to 30-day mortality for patients undergoing surgery with intermediate to high cardiac risk ( level of evidence , moderate ) .
***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 The French- Language Society of Paediatric Anaesthesiologists ( ADARPEF ) design ed a 1-year prospect i ve , multicenter and anonymous study to up date both epidemiology and morbidity of  regional anesthesia in children . METHODS From November 2005 to October 2006 , data from participating hospitals were recorded using an identification form , a data recording form , and a complication form . Information collected included the characteristics of the hospitals , the number and type of regional anesthetics ( RA ) , the age of the involved children as well as the incidence , and type of complications . RESULTS Data collected in 47 institutions included 104,612 pure general anesthesias ( GAs ) , 29,870 GAs associated with regional blocks , and 1262 pure regional blocks .  Central blocks accounted for 34 % of all RA . Peripheral blocks ( 66 % ) were upper or lower limb blocks ( 29 % of peripheral blocks ) , trunk blocks , and face blocks ( 71 % ) . In children aged ≤3 years , the percentage of central blocks was similar to the peripheral ones ( 45 % vs 55 ) , while in older children , peripheral blocks were more than four times used than central ones . Complications ( 41 involving 40 patients ) were rare and usually minor . They did not result in any sequelae . The study revealed an overall rate of complication of 0.12 % ; CI 95 % [ 0.09 - 0.17 ] , significantly six times higher for central than for peripheral blocks . CONCLUSIONS As a result of the low rate of complications , RA techniques have a good safety profile and can be used to provide postoperative analgesia . In addition , the results should encourage anesthesiologists to continue to use peripheral instead of central ( including caudal ) blocks as often as possible when appropriate PURPOSE : Colorectal surgery is associated with postoperative ileus , which contributes to delayed discharge . This study was design ed to investigate the effect of thoracic epidural anesthesia and analgesia on gastrointestinal function after colorectal surgery under st and ardized controlled postoperative care . METHODS : Forty-two patients diagnosed with either colonic cancer , diverticulitis , polyps , or adenoma , and scheduled for elective colorectal surgery , were r and omly assigned to either postoperative patient-controlled analgesia ( PCA ) with intravenous morphine ( n=21 ) or epidural analgesia with a mixture of bupivacaine and fentanyl ( n=21 ) . Postoperative early oral feeding and assistance to mobilization were offered to all patients . Pain visual analog scale ( 1–100 mm ) , passage of flatus and bowel movements , length of hospital stay , and readiness for discharge were recorded . RESULTS : Pain visual analog scale ( visual analog scale , 1–100 mm ) at rest , on coughing , and daily on mobilization was significantly lower in the epidural group compared with the patient-controlled analgesia group . Median values for the visual analog scale group were 7 ( 95 percent confidence interval , 2–18 ) mm , 19 ( 95 percent confidence interval , 4–38 ) mm , and 10 ( 95 percent confidence interval , 5–33 ) mm , respectively , and , for the patient-controlled analgesia group , were 24 ( 95 percent confidence interval , 18–51 ) mm , 59 ( 95 percent confidence interval , 33–74 ) mm , and 40 ( 95 percent confidence interval , 29–79 ) mm , respectively ( P<0.01 ) . Intake of protein and calories and time out of bed were similar in both groups . Mean time intervals ± st and ard deviation from surgery to first flatus and first bowel movement occurred earlier in the epidural group , 1.9±0.6 days and 3.1±1.7 days , respectively , compared with patient-controlled analgesia , 3.6±1.5 days and 4.6 ± 1.6 days , respectively ( P<0.01 ) . Postoperative complications occurred in 33 percent of the patient-controlled analgesia group and 28 percent of the epidural group . There was no significant difference in length of hospital stay between the two groups with a mean of 7.3±3.7 days in the patient-controlled analgesia group and 8.5±4.2 days in the epidural group . Readiness for discharge was similar in both groups . CONCLUSION : Thoracic epidural analgesia has distinct advantages over patient-controlled analgesia morphine in providing superior quality of analgesia and shortening the duration of postoperative ileus . However , discharge home was not faster , indicating that other perioperative factors influence the length of hospital stay UNLABELLED Anesthetic methods used during cesarean section have advantages and disadvantages to both mothers and infants and may result in short and long term neonatal effects . OBJECTIVE To determine the effects of general and regional anesthesia on the infants , a prospect i ve , r and omized trial was performed in Siriraj Hospital , Mahidol University . MATERIAL AND METHOD 341 uncomplicated pregnant women who were to be delivered at term by Cesarean section were recruited and r and omized to receive general anesthesia , GA ( 103 ) ; epidural anesthesia , EA ( 120 ) and spinal anesthesia , SA ( 118 ) . The immediate fetal and neonatal effects were assessed by cord blood gas analysis and the infant 's Apgar scores . The Neurologic and Adaptive Capacity Scores ( NACS ) was performed within 4 hours after birth by two pediatricians who were blind to the anesthetic method . RESULT Maternal age , weight , height , duration of the operation and infants ' birth weight were not different among the study groups . In the EA and SA group , maternal systolic blood pressure decreased more than 20 per cent from the baseline in more than half . The infants ' Apgar scores at 1 and 5 minutes were 8.3 + /- 1.9 ; 8.2 + /- 1.6 ; 6.7 + /- 2.8 , and 9.7 + /- 0.9 ; 9.8 + /- 0.7 ; 9.2 + /- 1.6 in EA , SA and GA group respectively . The adaptive capacity , active tone , passive tone , general assessment and primary reflexes of the NACS were not statistically different . CONCLUSION Apgar scores of the infants whose mothers received general anesthesia were lower than infants whose mothers received regional anesthesia but the NACS were not statistically different among the three study groups The actual incidence of neurologic dysfunction result ing from hemorrhagic complications associated with neuraxial blockade is unknown . Although the incidence cited in the literature is estimated to be less than 1 in 150,000 epidural and less than 1 in 220,000 spinal anesthetics , recent epidemiologic surveys suggest that the frequency is increasing and may be as high as 1 in 3000 in some patient population s. Overall , the risk of clinical ly significant bleeding increase with age , associated abnormalities of the spinal cord or vertebral column , the presence of an underlying coagulopathy , difficulty during needle placement , and an indwelling neuraxial catheter during sustained anticoagulation ( particularly with st and ard heparin or low-molecular weight heparin ) . The need for prompt diagnosis and intervention to optimize is also consistently reported . In response to these patient safety issues , the American Society of Regional Anesthesia and Pain Medicine ( ASRA ) convened its Third Consensus Conference on Regional Anesthesia and Anticoagulation . Practice guidelines or recommendations summarize evidence -based review s. However , the rarity of spinal hematoma defies a prospect i ve r and omized study , and there is no current laboratory model . As a result , the ASRA consensus statements represent the collective experience of recognized experts in the field of neuraxial anesthesia and anticoagulation . These are based on case reports , clinical series , pharmacology , hematology , and risk factors for surgical bleeding . An underst and ing of the complexity of this issue is essential to patient management Colonic surgery patients were studied to measure : the influence of continuous thoracic epidural analgesia ( TEA ) on a postoperative pain score , the time till onset of defaecation , blood loss , postoperative temperature elevations , rate of bacterial contamination of wounds and urine , and general surgical complications .  Group I patients ( n = 57 ) received general anaesthesia and TEA for the operation , followed by continuous TEA ( 0·25 per cent bupivacaine ) for 72 h.  Group II patients ( n = 59 ) received general anaesthesia for the operation , followed by systemic analgesia on request . Significant beneficial effects of TEA in group I were demonstrated by lower pain scores in the first 24 h after surgery and earlier defaecation . However , there were fewer temperature elevations in group II . There was no significant difference between the groups in terms of positive bacteriological cultures , blood loss , need for postoperative mechanical ventilation and complications . However , there was a trend toward a higher rate of rectal anastomotic breakdown , increased blood replacement and intensive care therapy , and longer hospitalization in group I. These results do not suggest any significant beneficial therapeutic effect of continuous TEA in colonic surgery compared with a conventional systemic analgesic regimen . In selected patients ( i.e. those with severe pain or those prone to develop postoperative ileus ) continuous TEA may be beneficial We have studied the effect of extradural analgesia on postoperative venous thrombosis in patients undergoing knee arthroplasty . Forty-eight patients were allocated r and omly to receive either general anaesthesia or extradural analgesia with local anaesthetics for 3 days . All patients wore compressive elastic stockings and no anticoagulant drugs were administered . Bilateral venography was performed 10 days after surgery . Continuous extradural analgesia did not impede mobilization of the patients . One case of nonfatal pulmonary embolism occurred in a patient who received general anaesthesia . The use of continuous extradural analgesia result ed in a significant difference in the total incidence of deep vein thrombosis ( 18 % compared with 59 % after general anaesthesia ( P = 0.02 ] . The incidence of calf vein thrombosis was 12 % compared with 45 % after general anaesthesia ( P = 0.05 ) Ninety healthy parturients undergoing elective caesarean section were r and omly allocated to receive either general ( n = 30 ) , epidural ( n = 30 ) or spinal ( n = 30 ) anaesthesia .  Acid-base status , Apgar score and neurobehavioural status , using the neurologic and adaptive capacity scoring ( NACS ) system , were studied in the newborn . Apgar scores and acid-base parameters were similar in all the three groups . NACS testing revealed significantly more vigorous babies in the spinal anaesthesia group than in the other two groups at 15 min and 2 h interval after delivery , despite a higher incidence of maternal hypotension . We conclude that newborns tend to have a better neurobehavioural status in the early post-delivery period if their mothers receive spinal anaesthesia rather than general or epidural anaesthesia for caesarean section Twenty-two patients undergoing upper abdominal surgery were entered into a r and omized , double-blind study to receive extradural ( T7-T8 ) 0.5 % bupivacaine 9 ml followed by 25 mg h-1 with or without additional extradural morphine ( bolus 4 mg plus 0.5 mg h-1 ) , for 16 h after operation . Addition of morphine was associated with total alleviation of pain , and a stable level of sensory analgesia , but not with changes in blood glucose and cortisol concentrations or postoperative impairment of lung function ( PEFR , FEV1 , FVC ) .  Two patients were withdrawn because of hypotension or respiratory depression The effects of thoracic epidural anesthesia ( TEA ) on total body oxygen supply-dem and ratio are complex due to potential influences on both O2 delivery ( & OV0422;O2 ) and consumption ( & OV0312;O2 ) . One hundred and five patients undergoing abdominal aortic surgery were r and omly assigned to one of three groups to compare the cardiovascular and metabolic responses associated with ( 1 ) thoracic epidural anesthesia plus light general anesthesia ( group TEA ) ; ( 2 ) general anesthesia with halothane ( group H ) ; and ( 3 ) neuroleptanalgesia ( group NLA ) . Values of cardiac index ( CI ) and & OV0422;O2 were less intra operatively in the TEA group than in the H or NLA groups , while & OV0312;O2 values were similar . & OV0312;O2 during recovery was greater in both the TEA and NLA groups than in the H group . Consequently the oxygen supply-dem and ratio ( & OV0422;O2/&OV0312;O2 ) was less in the TEA group throughout the perioperative period and about 30 % below baseline values during early recovery . At comparable & OV0312;O2 , CI and mixed venous O2 saturation were always less in the TEA group than in the NLA group . Heart rate was slowest intra operatively during TEA , and stroke work was less with TEA than with NLA . As cardiac filling pressure and systemic vascular resistance did not differ among the three groups , reduced adaptation of CI to t 
    Output:
    