Key recommendations support use of  opioid-sparing perioperative medications  , minimal preoperative fasting and early feeding , use of anesthetic techniques that decrease postoperative nausea and vomiting and pain , use of measures to prevent intraoperative hypothermia , and support of early mobilization after surgery .
Background : Enhanced recovery following surgery can be achieved through the introduction of evidence -based perioperative maneuvers .
This review aims to present a consensus for optimal perioperative management of patients undergoing breast reconstructive surgery  and to provide evidence -based recommendations for an enhanced perioperative protocol .
Aprepitant’s Prophylactic Efficacy in Decreasing Postoperative Nausea and Vomiting in Morbidly Obese Patients Undergoing Bariatric Surgery
Background Postoperative nausea and vomiting is a major cause of patient dissatisfaction towards surgery . For bariatric surgery , increased vomiting/retching is detrimental to surgical anastomosis . The present study evaluated the efficacy of aprepitant ( neurokinin-1 inhibitor ) as a prophylactic antiemetic in morbidly obese patients for laparoscopic bariatric surgery . Methods After institutional review board approval , 125 morbidly obese patients were recruited into this double-blind placebo-controlled trial . On r and om division , the patients received a tablet of aprepitant ( 80 mg ) in group A , or a similar-appearing placebo in group P , an hour prior to surgery . All patients received intravenous ondansetron ( 4 mg ) intraoperatively . Postoperatively , the patients were evaluated for nausea and vomiting by a blinded evaluator at 30 min , 1 , 2 , 6 , 24 , 48 , and 72 h. Results Both groups were evenly distributed for age , body mass index , type , and length of surgery . Cumulative incidence of vomiting at 72 h was significantly lower in group A ( 3 % ) compared to group P ( 15 % ; p = 0.021 ) . Odds ratio for vomiting in group P compared to group A was 5.47 times . On Kaplan – Meier plot , time to first vomiting was also significantly delayed in group A ( p = 0.019 ) . A higher number of patients showed complete absence of nausea or vomiting in group A compared to group P ( 42.18 vs. 36.67 % ) . On the other h and , nausea scores were unaffected by aprepitant , and no significant difference between groups was found at any of the measured time points . Conclusions In morbidly obese patients undergoing laparoscopic bariatric surgery , addition of aprepitant to ondansetron can significantly delay vomiting episodes simultaneously lowering the incidence of postoperative vomiting
Key recommendations support use of  opioid-sparing perioperative medications  , minimal preoperative fasting and early feeding , use of anesthetic techniques that decrease postoperative nausea and vomiting and pain , use of measures to prevent intraoperative hypothermia , and support of early mobilization after surgery .
Background : Enhanced recovery following surgery can be achieved through the introduction of evidence -based perioperative maneuvers .
This review aims to present a consensus for optimal perioperative management of patients undergoing breast reconstructive surgery  and to provide evidence -based recommendations for an enhanced perioperative protocol .