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 .
Amino acid infusions started after development of intraoperative core hypothermia do not affect rewarming but reduce the incidence of postoperative shivering during major abdominal surgery: a randomized trial
Purpose Previous studies have demonstrated that amino acid infusions exert enhanced thermogenic effects during general anesthesia . This study was conducted to investigate whether amino acid infusions started after development of intraoperative core hypothermia can accelerate rewarming . Methods Twenty-two patients scheduled for major abdominal surgery were included in this study . When tympanic temperature reached 35.5 ° C , patients were r and omly assigned to receive amino acids ( amino acid group ; n = 11 ) or saline ( saline group ; n = 11 ) . A continuous infusion of a mixture of 18 amino acids or saline was started at 200 ml h−1 . Tympanic , forearm , and digit temperatures were recorded . Forearm minus fingertip skin-surface temperature gradients ( temperature gradient ) were calculated . Postoperative shivering was also evaluated . Results Tympanic membrane temperature and temperature gradient were similar between the two groups at each time point during the study period . Temperature gradient at extubation in the amino acid group was significantly lower than in the saline group although tympanic temperature at extubation was similar between the two groups . Postoperative shivering score was significantly lower in the amino acid group than in the saline group . Conclusions Amino acid infusions started after development of intraoperative core hypothermia failed to accelerate rewarming . However , amino acid infusions reduced the incidence of postoperative shivering . Use of amino acid infusions to reduce thermoregulatory vasoconstriction at emergence might contribute to a decrease in the development of postoperative shivering
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 .