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 .
Dextran-Related Complications in Head and Neck Microsurgery: Do the Benefits Outweigh the Risks? A Prospective Randomized Analysis
Increased experience with free-tissue transfer has minimized flap loss secondary to microvascular thrombosis , yet pharmacologic antithrombotic prophylaxis continues to be used routinely . Currently there is no consensus on the ideal pharmacologic agent , dosing , or efficacy . Low-molecular-weight dextran has been widely used for prophylaxis due to its properties of volume expansion and enhanced microrheology . Significant systemic morbidity ( pulmonary morbidity , cardiac morbidity , anaphylaxis ) is known to occur with use of low-molecular-weight dextran . The purpose of this study was to evaluate morbidity associated with postoperative low-molecular-weight dextran and aspirin prophylaxis in head and neck microsurgery patients . This study was a r and omized prospect i ve analysis of 100 consecutive patients undergoing microvascular reconstruction for head and neck malignancy during a 2-year period . Patients were r and omized into one of three postoperative antithrombotic prophylaxis treatment groups : low-molecular-weight dextran 20 cc/hour for 48 hours ( n = 35 ) , low-molecular-weight dextran 20 cc/hour for 120 hours ( n = 32 ) , or aspirin 325 mg/day for 120 hours ( n = 27 ) . Six patients were excluded intraoperatively due to the need for systemic heparin therapy . Treatment groups were compared for age , sex , prior medical problems , duration of anesthesia , and intraoperative fluid intake . Flap outcome and the incidence of local and systemic complications were evaluated in the treatment groups . Patient ages ranged from 12 to 84 years ( mean age , 58 years ) . No significant difference was found among the treatment groups with respect to age , sex , prior medical problems , duration of anesthesia , intraoperative fluid intake , and the distribution of donor and recipient sites . There were no total flap losses and two partial flap losses in this series . Three flaps were reexplored and all were salvaged . The incidence of systemic complications ( congestive heart failure , myocardial infa rct ion , pulmonary edema , pleural effusion , and pneumonia ) was as follows : low-molecular-weight dextran 120 hours , 51 percent ; low-molecular-weight dextran 48 hours , 29 percent ; and aspirin , 7 percent . Analysis of these data suggests that the method of prophylaxis had no effect on overall flap survival . However , the incidence of systemic complications was significantly related to the method of prophylaxis , with patients receiving low-molecular-weight dextran 120 hours and 48 hours at a 7.2 and 3.9 times greater relative risk , respectively , of developing a systemic complication compared with patients receiving aspirin . The results of this study have eliminated the routine use of low-molecular-weight dextran prophylaxis at our institution in an effort to reduce morbidity in head and neck microsurgical reconstruction
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 .