A well-implemented ERAS protocol with good compliance is associated with a reduction in medical complications and length of hospital stay .
Enhanced recovery after surgery ( ERAS ) pathways are now implemented worldwide with strong evidence that adhesion to such protocol reduces medical complications , costs and hospital stay .
This concept has been applied for pancreatic surgery since the first published guidelines in 2012 .
This study presents the up date d ERAS recommendations for  pancreatoduodenectomy ( PD )  based on the best available evidence and on expert consensus .
Effect of dexmedetomidine on the minimum alveolar concentration (MAC) of sevoflurane in adults age 55 to 70 years.
STUDY OBJECTIVE To determine the effect of two target dexmedetomidine infusions ( 0.3 ng/ml and 0.6 ng/ml ) on the minimal alveolar concentration ( MAC ) of sevoflurane in adults age 55 to 70 years . DESIGN Prospect i ve , r and omized , placebo-controlled study . SETTING University-affiliated hospital . PATIENTS 45 ASA physical status I and II adults , age 55 to 70 years , undergoing elective surgery with at least a 3 inch skin incision . INTERVENTIONS Patients were given a dexmedetomidine or placebo infusion for at least 15 minutes before anesthetic induction with sevoflurane in oxygen by face mask . After tracheal intubation , a target sevoflurane concentration was maintained for 15 minutes while the dexmedetomidine or placebo infusion continued to run . MEASUREMENTS AND MAIN RESULTS At the time of skin incision , two observers independently determined movement or nonmovement to the incision . Blood sample s for dexmedetomidine were taken before the infusion and at the time of skin incision . The  dexmedetomidine plasma concentrations were 0 before infusion with all treatment groups . At the time of incision , they were 0 in the placebo group , 0.39 + /- 0.13 ng/ml in the 0.3 ng/ml target group , and 0.7 + /- 0.13 ng/ml in the 0.6 ng/ml target group . The MAC of sevoflurane was 1.83 % in the placebo group , 1.78 % in the 0.3 ng/ml target dexmedetomidine group , and 1.51 % in the 0.6 ng/ml target dexmedetomidine group . CONCLUSIONS Dexmedetomidine 0.7 ng/ml decreased the MAC of sevoflurane by 17 % , whereas there was no difference between the placebo and the dexmedetomidine 0.39 ng/ml group
A well-implemented ERAS protocol with good compliance is associated with a reduction in medical complications and length of hospital stay .
Enhanced recovery after surgery ( ERAS ) pathways are now implemented worldwide with strong evidence that adhesion to such protocol reduces medical complications , costs and hospital stay .
This concept has been applied for pancreatic surgery since the first published guidelines in 2012 .
This study presents the up date d ERAS recommendations for  pancreatoduodenectomy ( PD )  based on the best available evidence and on expert consensus .