A well-implemented ERAS protocol with good compliance is associated with a reduction in medical complications and length of hospital stay .
Enhanced recovery after surgery ( ERAS ) pathways are now implemented worldwide with strong evidence that adhesion to such protocol reduces medical complications , costs and hospital stay .
This concept has been applied for pancreatic surgery since the first published guidelines in 2012 .
This study presents the up date d ERAS recommendations for  pancreatoduodenectomy ( PD )  based on the best available evidence and on expert consensus .
Minimum Effective dose of Dexamethasone in Combination with Midazolam as Prophylaxis against Postoperative Nausea and Vomiting after Laparoscopic Cholecystectomy
Background : Postoperative nausea and vomiting ( PONV ) affects 20 % and 30 % of patients . As many as 60%–80 % patients at high risk may be affected . Dexamethasone ( D ) and midazolam ( M ) are well studied as antiemetic . Use of D can be associated with certain undesirable side effects so minimum dose is preferred . M is a routinely used premedicant . Hence , this study was design ed with both D and M in high risk patients for PONV to find minimum effective dose of D. Aims : To determine the minimum dose of D that combined with M would provide effective prophylaxis of PONV after laparoscopic cholecystectomy ( LC ) in patients at high risk for PONV . Setting and Design : This is a prospect i ve , r and omized double-blind trial . Material s and Methods : One hundred and fifty-five patients scheduled for elective LC were r and omized to 5 groups of 31 each . Group C was given normal saline , and the rest were administered D 1 mg ( group MD1 ) , 2 mg ( group MD2 ) , 4 mg ( group MD4 ) , or 8 mg ( group MD8 ) in combination with 0.04 mg/kg M at induction . The incidence of nausea , vomiting , severity of nausea , and the use of rescue antiemetic and postoperative pain was analyzed . Statistical Analysis : Chi-square test was used to compare incidence of study variables . Independent Student 's t-test was used for continuous variables . Demographic data were compared using ANOVA . P < 0.05 was considered statistically significant . Results : The incidence of nausea was significantly lower in group MD4 ( 29 % ) and MD8 ( 6 % ) compared to placebo group ( 71 % ) ( P < 0.001 ) and of vomiting was significantly lower in groups of MD2 ( 58 % ) , MD4 ( 48 % ) , and MD8 ( 6 % ) compared with placebo ( 90 % ) ( P < 0.001 ) at 24 h. There was significant reduction in nausea , pain severity , and incidence of use of rescue antiemetic in MD4 and MD8 groups with no discernable side effects of the drugs . Conclusion : We conclude that 4 mg D with M and 2 mg D with M is effective for prevention of nausea and vomiting , respectively , in patients at high risk for PONV undergoing LC
A well-implemented ERAS protocol with good compliance is associated with a reduction in medical complications and length of hospital stay .
Enhanced recovery after surgery ( ERAS ) pathways are now implemented worldwide with strong evidence that adhesion to such protocol reduces medical complications , costs and hospital stay .
This concept has been applied for pancreatic surgery since the first published guidelines in 2012 .
This study presents the up date d ERAS recommendations for  pancreatoduodenectomy ( PD )  based on the best available evidence and on expert consensus .