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 .
Effect of anaesthetic technique on the natural killer cell anti-tumour activity of serum from women undergoing breast cancer surgery: a pilot study.
BACKGROUND Animal models and retrospective clinical data suggest that certain anaesthetic techniques can attenuate immunosuppression and minimize metastasis after cancer surgery . Natural killer ( NK ) T cells are a critical component of the anti-tumour immune response . We investigated the effect of serum from women undergoing primary breast cancer surgery , r and omized to propofol-paravertebral block ( PPA ) or sevoflurane-opioid ( GA ) anaesthetic techniques  , on healthy human donor NK cell function and cytotoxicity against oestrogen and progesterone receptor-positive breast cancer cells ( HCC1500 ) . METHODS Ten subjects who donated serum before operation and 24 h after operation in an ongoing r and omized prospect i ve trial ( NCT 00418457 ) were r and omly selected . Serum from PPA ( n=5 ) and GA ( n=5 ) subjects was co-cultured with HCC1500 and healthy primary NK cells . NK cell activating receptors ( NKp30 , NKp44 , NKp46 , 2b4 , CD16 , NKG2D ) , cytokine production , NK CD107a expression , and cytotoxicity towards HCC1500 were examined . RESULTS Serum from PPA subjects did not alter normal NK marker expression or secretion of cytokines . Serum from GA subjects reduced NK cell activating receptor CD16 [ from mean ( sem ) , 82 (2)% to 50 (4)% , P=0.001 ] , IL-10 [ from 1700 ( 80 ) to 1200 ( 92 ) pg ml(-1 ) , P=0.001 ] , and IL-1β [ from 68 ( 12 ) to 19 ( 4 ) pg ml(-1 ) , P=0.01 ] . An increase in NK cell CD107a [ 23 (2)% to 37(3)% , P=0.007 ] and apoptosis of HCC1500 [ 11 (1)% to 21 (2)% , P=0.0001 ] was observed with PPA serum , but not GA serum , treated NK cells . CONCLUSION Serum from women with breast cancer undergoing surgical excision who were r and omized to receive a PPA anaesthetic technique led to greater human donor NK cell cytotoxicity in vitro compared with serum from women who received GA . CLINICAL TRIAL REGISTRATION NCT 041857
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 .