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Table 1 Checklist of fast track and conventional perioperative operation treatments

From: Fast track multi-discipline treatment (FTMDT trial) versus conventional treatment in colorectal cancer--the design of a prospective randomized controlled study

Time Fast track treatment Conventional treatment
Preadmission -Psychological optimism -No psychological optimism
(After randomization) -Pre-assessment for risk adjustment -Pre-assessment for risk adjustment
  -Anesthesiologic information of combined anesthesia consisting of thoracic
epidural and general anesthesia
-No Anesthesiologic information of general anesthesia
  -Information of the fast track treatment and the informed consent -Information of the conventional treatment and the informed consent
  -Guided tour of fast track wards -No tour
  -Operation schedule -Operation schedule
Preoperation -Bowel preparation: semiliquid diet 1 days before operation -Bowel preparation: liquid diet 1-2 days before operation
  - Enemas: -Enemas:
  Polyethylene Glycol-Electrolyte Powder ® (Hengkang Zhengqing™, Jiangxi
Hygecon Pharmacy CO., Ltd, Shangrao, CN) the afternoon before surgery,2
boxes mixing with 2,000 ml warm drinking water
Polyethylene Glycol-Electrolyte Powder ® the afternoon before surgery, 2 boxes mixing with 2000 ml warm drinking water
  -Fasting: last meal 2 h before operation -Fasting: last meal 10 h before operation
  -Complete Enteral Nutritional Emulsion Supportan (TPF-T) ® (Supportan™,
Sino-Swed Pharmaceutical CO. Ltd, Wuxi, CN) 600 ml or Fresubin Diabetes
(TPF-D) ® (Fresubin Diabetes™, Sino-Swed Pharmaceutical CO. Ltd, Wuxi,
CN) 500 ml (especially for patients with diabetes mellitus) p.o. 8 h before operation
- No oral intake in the operation day
  - 10% Glucose 400 ml p.o. 2-3 h before operation - No oral intake in the operation day
  - Nasogastric tube 0.5 h before operation for Gastrointestinal decompression - Nasogastric tube 0.5 h before operation for Gastrointestinal decompression
Intraoperation
-Anesthetic managemen - Placement of epidural catheter (T6-L1), depending on the surgical resection);
test-dose (3 ml of 2% lidocaine (Hefeng™, Harvest Pharmaceutical CO. Ltd,
Shanghai, CN)) followed by continuous infusion (10 ml of 0.5% or 0.75%
ropivacaine(Naropin™, APP Pharmaceuticals, LLC., Schaumburg, IL)
according to the age and size of the patient before surgical incision
- No thoracic epidural anesthesia
  - Balanced Combination with general anesthesia: intravenous midazolam
(Liyuexi™, Nhwa Pharmaceutical Co., Ltd., Xuzhou, CN) (0.1 mg/kg),
target-controlled infusion (TCI) of propofol (Diprivan™,
AstraZeneca Pharmaceutical Co., Ltd.,
Shanghai, CN) (4-8 μg/ml), sufentanil (Fukang™,
Humanwell Pharmaceutical Co., Ltd., Yichang, CN) (0.5-1 µg/kg), rocuronium
(Esmeron™, Organon Teknika B.V., Oss, NL) (0.6-0.9 mg/kg).
- Normal General anesthesia: intravenous midazolam (0.1 mg/kg), target-controlled infusion (TCI) of propofol (4-8 μg/ml), sufentanil 0.5-1 µg/kg, rocuronium (0.6-0.9 mg/kg).
  The patients were ventilated mechanically. The patients were ventilated mechanically.
  Anesthesia was maintained propofol TCI (2-4 μg/ml), remifentanil
(0.02-0.03 μg/kg/min) and intermittent boluses of rocuronium.
Anesthesia was maintained propofol TCI (2-4 μg/ml), remifentanil (Ruijie™, Humanwell Pharmaceutical Co., Ltd., Yichang, CN) (0.02-0.03 μg/kg/min) and intermittent boluses of rocuronium.
   As equally depth of anesthesia is also needed in conventional treatment group with no thoracic epidural anesthesia, more drug dosage of general anesthesia is used.
  - Morphia as little as possible - No restriction of Morphia use
  - Monitoring: (Datex Ohmeda™ S/5 Anesthesia Monitor (Datex-Ohmeda Division,
Instrumentarium Corp., Helsinki, Finland)) consists of electrocardiogram (ECG),
heart rate (HR), respiratory rate, arterial pressure (BP), SpO2, end-tidal CO2
(etCO2), and bispectral index (BIS). - The target concentration of propofol:keep
BIS between 40 and 60 to maintain adequate hypnosis. - Perioperative
hypotension:systolic blood pressure (SBP) < 80 mmHg or a decrease
of 30% baseline value and was treated with reduction of anesthetics,
fluid supplement, and a bolus dose of ephedrine (Mahuangsu™, Northeast
Pharmaceutical Co., Ltd., Shenyang, CN) (10 mg, IV). If SBP was above
160 mmHg or increase > 30%, an increase of propofol or remifentanil infusion
was given to deepen anesthesia.
- Monitoring: the same as fast-track group
-Antibiotic prophylaxis - Yes, - Yes
-Surgical management -Laparoscopic/open surgery as randomization -Laparoscopic/open surgery as randomization
- Warming - Yes, body warming by thickening quilt as well as intravenous fluid warming - No body and intravenous fluid warming
- Drains - Minimal use and early removal of abdominal drains -Regularly use and removal of abdominal drains
- Fluid infusion - Totally ≤ 1,500 ml during operation - No restriction
Postoperation
- Pain management -Patient-controlled continuous epidural analgesia with a 5 ml/h continuous
infusion of 0.15% ropivacaine and a bolus dose of 2.5 ml (locktime 15 min)
until 48 h after operation, paracetamol (Tylenol™, Johnson & Johnson
Pharmaceutical Co., Ltd., Shanghai, CN) p.o. when needed
-Patient-controlled intravenous analgesia with a 4 ug/h continuous infusion of sufentanil and a bolus dose of 1.5 μg (locktime 15 min)
   -Bucinperazine (QiangtongdingTM, Northeast Pharmaceutical Co., Ltd., Shenyang, CN) or Morphine (Mafei™, Northeast Pharmaceutical Co., Ltd., Shenyang, CN) intramuscular injection when patient-controlled intravenous analgesia isn't enough for pain control
- Diet - Chewing gum 1 piece tid p.o. -No chewing gum
  - At least 10% Glucose 200 ml p.o. within 24 h after operation - Fasting until flatus
  -Liquid diet and Enteral Nutritional Emulsion Supportan 200 ml or
Fresubin Diabetes 300 ml (especially for patients with diabetes mellitus)
p.o. the next day of operation
- Liquid diet after flatus
  - Diet rehabilitation as early as possible (dose increase of Enteral
Nutritional Emulsion or when needed)
- Normal diet after defecation
- Intravenous fluid infusion - Stop intravenous high energy fluid infusion after dosage of Enteral
Nutritional Emulsion Supportan ≥ 600 ml or Enteral Nutritional
Emulsion Fresubin Diabetes ≥ 500 ml
- Intravenous high energy fluid infusion on daily basis and continuing until adequate oral intake
  - No intravenous High-energy Nutrient Fluid after 72 h post-surgery  
  - Restricting and avoiding excessive intravenous fluid infusion,
keeping body weight as pre-surgery
 
- Energy - Keep the total energy intake (both diet and intravenous fluid infusion)
25-30 kcal/kg/day
- Keep the total energy intake (both diet and intravenous fluid infusion) 25-30 kcal/kg/day
- Nasogastric tube
and urethral catheter
-Remove nasogastric tube as soon as the end of operation - Remove nasogastric tube after 1st flatus postoperation
  - Remove urethral catheter within 24-48 h after operation -Remove urethral catheter when 1st time meet: patient have the feeling of automatic micturition and 200 ml after valving-on urethral catheter
- Ambulation - Forced ambulation within 24 h post-surgery, no time restriction - No ambulation scheme
  - Ambulation time ≥ 1 h per day, and increasing day by day  
  - Patients walking to weight themselves every day  
Adjuvant
chemotherapy - Xelox - mFolfox6
  - repeat every 3 weeks for 8 cycles - repeat every 2 weeks for 12 cycles
  - Regimen - Regimen
  Oxaliplatin 130 mg/m2 day 1, Capecitabine (Xeloda™) 850-1,000
mg/m2 twice daily for 14 days -
Oxaliplatin (EloxatinTM) 85 mg/m2 IV over 2 hours, day .1 Leucovorin (Tongao™) 400 mg/m2 IV over 2 hours, day 1. 5-FU (Jinyao™) 400 mg/m2 IV bolus on day 1, then 1,200 mg/m2/day × 2 days (total 2,400 mg/m2 over 46-48 hours) continuous infusion
  - No peripherally inserted central catheter (PICC) - Peripherally inserted central catheter and care of PICC in outpatient clinic every week
  - Hospitalization no more than 24 h each cycle - Hospitalization for 3 days each cycle