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 .
Efficacy of external warming in attenuation of hypothermia in surgical patients.
BACKGROUND / AIM Hypothermia in surgical patients can be the consequence of long duration of surgical intervention , general anaesthesia and low temperature in operating room . Postoperative hypothermia contributes to a number of postoperative complications such as arrhythmia , myocardial ischemia , hypertension , bleeding , wound infection , coagulopathy , and prolonged effect of muscle relaxants . External heating procedures are used to prevent this condition . The aim of this study was to evaluate the efficiency of external warming system in alleviation of cold stress and hypothermia in patients who underwent major surgical procedures . METHODS The study was conducted in the Military Medical Academy in Bel grade . A total of 30 patients of both genders underwent abdominal surgical procedures , r and omly divided into two equal groups : the one was externally warmed using warm air mattress ( W ) , while in the control group ( C ) surgical procedure was performed in regular conditions , without additional warming . Oesophageal temperature ( Te ) was used as indicator of changes in core temperature , during surgery and awakening postoperative period , and temperature of control sites on the right h and ( Th ) and the right foot ( Tf ) reflected the changes in skin temperatures during surgery . Te and skin temperatures were monitored during the intraoperative period , with continuous measurement of Te during the following 90 minutes of the postoperative period . Heart rates and blood pressures were monitored continuously during the intraoperative and awakening period . RESULTS In the W group , the average Te , Tf and Th did not change significantly during the intraoperative as well as the postoperative period . In the controls , the average Te significantly decreased during the intraoperative period ( from 35.61 ± 0.35 ° C at 0 minute to 33.86 ± 0.51 ° C at 120th minute ) . Compared to the W group , Te in the C group was significantly lower in all the observed periods . Average values of Tf and Th significantly decreased in the C group ( from 30.83 ± 1.85 at 20th minute to 29.0 ± 1.39 ° C at 120th minute , and from 32.75 ± 0.96 to 31.05 ± 1.09 ° C , respectively ) . CONCLUSION The obtained results confirm that the external warming using warm air mattress was able to attenuate hypothermia , i.e. substantial decrease in core temperature , compared with the similar exposure to cold stress in the control group
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 .