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 .
A Randomized Comparison of Intraoperative PerfecTemp and Forced-Air Warming During Open Abdominal Surgery
BACKGROUND : The PerfecTemp is an underbody resistive warming system that combines servocontrolled underbody warming with viscoelastic foam pressure relief . Clinical efficacy of the system has yet to be formally evaluated . We therefore tested the hypothesis that intraoperative distal esophageal ( core ) temperatures with the PerfecTemp ( underbody resistive ) warming system are noninferior to upper-body forced-air warming in patients undergoing major open abdominal surgery under general anesthesia . METHODS : Adults scheduled for elective major open abdominal surgery ( liver , pancreas , gynecological , and colorectal surgery ) under general anesthesia were enrolled at 2 centers . Patients were r and omly assigned to underbody resistive or forced-air warming . Resistive heating started when patients were transferred to the operating room table ; forced-air warming started after patients were draped . The primary outcome was noninferiority of intraoperative time-weighted average core temperature , adjusted for baseline characteristics and using a buffer of 0.5 ° C . RESULTS : Thirty-six patients were r and omly assigned to underbody resistive heating and 34 to forced-air warming . Baseline and surgical characteristics were generally similar . We had sufficient evidence ( P = 0.018 ) to conclude that underbody resistive warming is not worse than ( i.e. , noninferior to ) upper-body forced-air warming in the time-weighted average intraoperative temperature , with a mean difference of −0.12 ° C [ 95 % confidence interval ( CI ) −0.37 to 0.14 ] . Core temperatures at the end of surgery averaged 36.3 ° C [ 95 % CI 36 to 36.5 ] in the resistive warming patients and 36.6 ° C [ 95 % CI 36.4 to 36.8 ] in those assigned to forced-air warming for a mean difference of −0.34 ° C [ 95 % CI −0.69 to 0.01 ] . CONCLUSIONS : Mean intraoperative time-weighted average core temperatures were no different , and significantly noninferior , with underbody resistive heating in comparison with upper-body forced-air warming . Underbody resistive heating may be an alternative to forced-air warming
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 .