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 .
Magnesium sulfate infusion prevents shivering during transurethral prostatectomy with spinal anesthesia: a randomized, double-blinded, controlled study.
STUDY OBJECTIVE To determine whether magnesium sulfate ( MgSO(4 ) ) infusion during surgery reduces shivering during spinal anesthesia . DESIGN Double-blinded placebo-controlled , r and omized trial . SETTING Operation room of a university hospital . PATIENTS 60 patients , aged 40 to 70 years , scheduled for elective transurethral resection of the prostate ( TURP ) during spinal anesthesia . INTERVENTIONS Subarachnoid anesthesia consisting of hyperbaric bupivacaine three mL 0.5 % was injected using a 25-G Quincke spinal needle . Patients received either saline ( Group C , n = 30 ) or MgSO(4 ) ( Group Mg , n = 30 ) . Group Mg received an intravenous ( IV ) bolus of MgSO(4 ) 80 mg/kg via syringe pump over a 30-minute period , followed by a two g/hr infusion during the intraoperative period . Group C received an equal volume of saline . MEASUREMENTS Motor blockade was evaluated by Bromage motor scale . Sensory block level was assessed by pinprick test . Shivering was assessed after the completion of subarachnoid drug injection . Side effects were recorded . MAIN RESULTS Hypothermia was observed in all patients ( 100 % ) in Group Mg and in 24 patients ( 80 % ) in Group C ( P = 0.024 ) . The decrease in core temperature in Group Mg was significantly greater ( P < 0.005 ) . Shivering was observed in two patients ( 6.7 % ) in Group Mg and 20 patients ( 66.7 % ) in Group C ( P = 0.0001 ) . CONCLUSIONS MgSO(4 ) infusion in the perioperative period significantly reduced shivering during TURP with spinal anesthesia . MgSO(4 ) infusion prevents shivering in patients receiving spinal anesthesia but increases the risk of hypothermia
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 .