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 .
Preventing opioid-induced nausea and vomiting: Rest your head and close your eyes?
Although opioid-induced nausea and vomiting ( OINV ) is common and debilitating , its mechanism is still unclear . Recently , we suggested that opioids affect semicircular canal function and that this leads to a mismatch between canal input and other sensory information during head motion , which triggers OINV . Here , we assess if visual input is relevant for this mismatch . In a r and omized-controlled crossover study 14 healthy men ( 26.9±3.4 years , mean±SD ) were tested twice , once blindfolded and once with eyes open , with at least one-day washout . The opioid remifentanil was administered intravenously ( 0.15 μg/kg/min ) for 60 minutes . After a thirty-minutes resting period , subjects ’ head and trunk were passively moved . Nausea was rated before remifentanil start ( T0 ) , before the movement intervention ( T30 ) and after 60 minutes ( T60 ) of administration . At rest ( T0 , T30 ) , median nausea ratings were zero whether subjects were blindfolded or not . Movement triggered nausea independently of visual input ( nausea rating 1.5/3.0 ( median/interquartile range ) in the blindfolded , 2.5/6 in the eyes-open condition , χ2(1 ) = 1.3 , p = 0.25 ) . As movement exacerbates OINV independently of visual input , a clash between visual and semicircular canal information is not the relevant trigger for OINV . To prevent OINV , emphasis should be put on head-rest , eye-closure is less important
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 .