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 .
Effects of a Circulating-water Garment and Forced-air Warming on Body Heat Content and Core Temperature
Background : Forced-air warming is sometimes unable to maintain perioperative normothermia . Therefore , the authors compared heat transfer , regional heat distribution , and core rewarming of forced-air warming with a novel circulating-water garment . Methods : Nine volunteers were each evaluated on two r and omly ordered study days . They were anesthetized and cooled to a core temperature near 34 ° C . The volunteers were subsequently warmed for 2.5 h with either a circulating-water garment or a forced-air cover . Overall , heat balance was determined from the difference between cutaneous heat loss ( thermal flux transducers ) and metabolic heat production ( oxygen consumption ) . Average arm and leg ( peripheral ) tissue temperatures were determined from 18 intramuscular needle thermocouples , 15 skin thermal flux transducers , and “ deep ” h and and foot thermometers . Results : Heat production ( approximately 60 kcal/h ) and loss ( approximately 45 kcal/h ) were similar with each treatment before warming . The increases in heat transfer across anterior portions of the skin surface were similar with each warming system ( approximately 65 kcal/h ) . Forced-air warming had no effect on posterior heat transfer , whereas circulating-water transferred 21 ± 9 kcal/h through the posterior skin surface after a half hour of warming . Over 2.5 h , circulating water thus increased body heat content 56 % more than forced air . Core temperatures thus increased faster than with circulating water than forced air , especially during the first hour , with the result that core temperature was 1.1 ° ± 0.7 ° C greater after 2.5 h ( P < 0.001 ) . Peripheral tissue heat content increased twice as much as core heat content with each device , but the core-to-peripheral tissue temperature gradient remained positive throughout the study . Conclusions : The circulating-water system transferred more heat than forced air , with the difference result ing largely from posterior heating . Circulating water rewarmed patients 0.4 ° C/h faster than forced air . A substantial peripheral-to-core tissue temperature gradient with each device indicated that peripheral tissues insulated the core , thus slowing heat transfer
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 .