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 .
Warmed irrigation fluid does not decrease perioperative hypothermia during arthroscopic shoulder surgery.
PURPOSE To compare the clinical efficacy of warmed irrigation fluid and room-temperature fluid in decreasing perioperative hypothermia during arthroscopic rotator cuff surgery . METHODS In this prospect i ve , r and omized , comparative study , warmed ( 36 ° C ) arthroscopic irrigation fluid ( group W , n = 36 ) or room-temperature irrigation fluid ( group RT , n = 36 ) was used without intraoperative warming devices  during arthroscopic shoulder surgery in 72 patients . The serial core body temperature and the last and lowest core body temperatures were measured by use of an esophageal stethoscope with a thermometer and a digital tympanic thermometer at 15-minute intervals during the operation and recovery period , respectively . When patients arrived in the postanesthesia care unit ( PACU ) after surgery , they were warmed immediately and monitored thereafter for body temperature and development of hypothermia-related adverse effects such as postoperative shivering and cardiac events . We evaluated the changes in the patients ' weight and prothrombin time on postoperative day 1 and the hemoglobin level and visual analog scale pain score immediately after the operation and on postoperative day 1 . RESULTS The 2 groups did not differ in demographic and surgical data and incidence of intraoperative hypothermia ( 33 of 36 [ 91.6 % ] in group RT and 34 of 36 [ 94.4 % ] in group W , P = .276 ) . The core body temperatures decreased throughout the surgery and increased linearly in the PACU , without any intergroup differences ( P > .05 ) . All patients were normothermic within 1 hour of arrival in the PACU . The 2 groups did not differ in postoperative weight change , prothrombin time , hemoglobin level , or postoperative visual analog scale pain score ( all P > .05 ) . Postoperative shivering occurred in 3 patients and 1 patient in group RT and group W , respectively . No cardiac events occurred in either group . CONCLUSIONS Warmed irrigation fluid was not superior to room-temperature irrigation fluid in reducing the occurrence of perioperative hypothermia during arthroscopic shoulder surgery . LEVEL OF EVIDENCE Level I , r and omized controlled trial
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 .