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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 (Hefengâ„¢, Harvest Pharmaceutical CO. Ltd,

Shanghai, CN)) followed by continuous infusion (10 ml of 0.5% or 0.75%

ropivacaine(Naropinâ„¢, 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

(Liyuexiâ„¢, Nhwa Pharmaceutical Co., Ltd., Xuzhou, CN) (0.1 mg/kg),

target-controlled infusion (TCI) of propofol (Diprivanâ„¢,

AstraZeneca Pharmaceutical Co., Ltd.,

Shanghai, CN) (4-8 μg/ml), sufentanil (Fukang™,

Humanwell Pharmaceutical Co., Ltd., Yichang, CN) (0.5-1 µg/kg), rocuronium

(Esmeronâ„¢, 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 Ohmedaâ„¢ 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 (Mahuangsuâ„¢, 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 (Tylenolâ„¢, 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 (Mafeiâ„¢, 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 (Xelodaâ„¢) 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