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 .
Changes in central venous saturation after major surgery, and association with outcome
Introduction Despite recent interest in measurement of  central venous oxygen saturation ( ScvO2 ) , there are no published data describing the pattern of ScvO2 changes after major general surgery or any relationship with outcome . Methods  ScvO2 and other biochemical , physiological and demographic data were prospect ively measured for 8 hours after major  surgery  .  Complications and deaths occurring within 28 days of enrolment were included in the data analysis . Independent predictors of complications were identified with the use of logistic regression analysis . Optimum cutoffs for ScvO2 were identified by receiver operator characteristic analysis . Results Data from 118 patients was analysed ; 123 morbidity  episodes occurred in 64 these patients . There were 12 deaths ( 10.2 % ) . The mean ± SD age was 66.8 ± 11.4 years . Twenty patients ( 17 % ) underwent emergency surgery and 77 patients ( 66 % ) were male . The mean ± SD P-POSSUM ( Portsmouth Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity ) score was 38.6 ± 7.7 , with a predicted mortality of 16.7 ± 17.6 % . After multivariate analysis , the lowest cardiac index value ( odds ratio ( OR ) 0.58 ( 95 % confidence intervals 0.37 to 0.9 ) ; p = 0.018 ) , lowest ScvO2 value ( OR 0.94 ( 0.89 to 0.98 ) ; p = 0.007 ) and P-POSSUM score ( OR 1.09 ( 1.02 to 1.15 ) ; p = 0.008 ) were independently associated with post-operative complications . The optimal ScvO2 cutoff value for morbidity prediction was 64.4 % . In the first hour after surgery , significant reductions in ScvO2 were observed , but there were no significant changes in CI or oxygen delivery index during the same period . ConclusionS ignificant fluctuations in ScvO2 occur in the immediate post-operative period . These fluctuations are not always associated with changes in oxygen delivery , suggesting that oxygen consumption is also an important determinant of ScvO2 . Reductions in ScvO2 are independently associated with post-operative complications
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 .