Despite anesthetic and surgical improvements in recent decades, postoperative morbidity remains a common drawback of major surgery. One of the main pathogenic factors leading to morbidity is the surgical stress response. A better understanding of this cascade mediated by the central nervous system, resulting in a systemic release of stress hormones and inflammatory mediators, has led to the development of care pathways attempting to reduce this response. Although no single element can eliminate postoperative morbidity and mortality, a combination of changes could likely reduce postoperative morbidity and lower hospital costs. The concept of a fast track recovery was introduced in the 1990s. It was found that applying evidence-based perioperative principles to patients undergoing open colonic surgery could halve the rate of postoperative complications and shorten the length of stay (LOS) in the hospital [1].

This multimodal perioperative care pathway has evolved into enhanced recovery after surgery (ERAS). The initial changes have been complemented by a multitude of measures with proven or probable impact on the surgical stress response. Current ERAS protocols include> 20 elements (Fig. 1) and reduce both morbidity and LOS [1]. To assist the transfer from colonic surgery, members of the