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 .
The Effect of Intravenous Dopamine and Dobutamine on Blood Circulation During a Microvascular TRAM Flap Operation
A study was conducted to assess the effect of intraoperatively administered inotropic agents on blood flow in the recipient and donor vessels , during breast reconstruction with a muscle sparing free TRAM flap . Twenty-one consecutive patients were r and omized into 3 groups receiving either dopamine , dobutamine , or placebo . When the flap and all vessels had been fully dissected but not yet divided , the study drug was administered intravenously for 15 minutes . Hemodynamic parameters and transit-time flow of the thoracodorsal and inferior epigastric arteries were monitored . Both dobutamine and dopamine infusions result ed in significant raises in cardiac output and mean arterial pressure . However , while dobutamine result ed in a higher cardiac output ( P = 0.001 ) and a decrease in systemic vascular resistance ( P = 0.028 ) , the increase in mean arterial pressure was greater with dopamine ( P = 0.002 ) . Only the dobutamine group showed increased blood flow , in both the thoracodorsal ( P = 0.043 ) and the inferior epigastric ( P = 0.043 ) arteries . If vasoactive agents are needed during microvascular anesthesia , dobutamine seems to be more advantageous than dopamine
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 .