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 .
Anaesthesia for day case excisional breast biopsy: propofol–remifentanil compared with sevoflurane–nitrous oxide
Background and objective A r and omized and prospect i ve study was performed to compare anaesthetic characteristics and stress hormone responses of two anaesthetic techniques . Methods Forty‐two patients undergoing day case excisional biopsy of breast mass were r and omly assigned to receive propofol – remifentanil or sevoflurane – N2O . Anaesthesia was induced and maintained either with sevoflurane and 50 % N2O in oxygen or with target‐controlled remifentanil and propofol in 50 % oxygen and air . Anaesthetic depth was monitored by the bispectral index . Results The times for induction ( 2.9 vs. 1.7 min ) and for laryngeal mask insertion ( 5.7 vs. 3.3 min ) were longer in the sevoflurane – N2O group than in the propofol – remifentanil group . However , apnoea ( 57.1 % vs. 9.5 % ) and bradycardia ( 23.8 % vs. 0 % ) were more prevalent with propofol – remifentanil . In the sevoflurane – N2O group , the emergence times to a verbal response ( 10.6 vs. 3.7 min ) , to extubation ( 11.8 vs. 4.0 min ) and to orientation ( 14.7 vs. 4.8 min ) were longer than in the propofol – remifentanil group . There were significantly more nausea ( 38.1 % vs. 4.8 % ) and vomiting ( 19.2 % vs. 0 % ) in the sevoflurane – N2O group than in the propofol – remifentanil group . The time to discharge was similar although there was less postoperative pain in the sevoflurane – N2O group . There were no differences in the perioperative cortisol responses in the two groups . Conclusions Smoother induction of anaesthesia was seen with sevoflurane – N2O . Propofol – remifentanil showed a quicker emergence with less nausea/vomiting . There were similar perioperative cortisol responses in the two anaesthetic techniques
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 .