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Table 1 The essence of the fast track care program and standard care program.

From: Perioperative strategy in colonic surgery; LA paroscopy and/or FA st track multimodal management versus standard care (LAFA trial)

  FAST-TRACK CARE STANDARD CARE
PRE-OPERATIVE PHASE   
Outpatient department of Surgery - Scheduling of operation
-Information about the fast track program
-Informed consent
- Scheduling of operation
-Informed consent
Outpatient department of anesthesiology - Pre-assessment for risk adjustment
-Discussion focusing on placement of thoracic epidural catheter for management of perioperative analgesia
-Discussion of the essence of the fast track program
- Pre-assessment for risk adjustment
-Open discussion about different possibilities for management of perioperative analgesia
Pre-admission counseling and guided tour on surgical ward - Yes - No
DAY OF ADMISSION   
Intake - Additional fast track information - Routine
Bowel preparation - Only enema - Only enema
Pre-operative carbohydrate loaded liquids - 4 units (preOp®) - No
Diet - Last meal 6 h before operation - Last meal until midnight
Pre-anesthetic evening medication - Lorazepam, 1 mg the evening before operation, if necessary - Lorazepam, 1 mg or Temazepam 10 or 20 mg
DAY OF SURGERY   
Pre-operative fasting - No, 2 units CHL 2 h before surgery - Yes
Pre-anesthetic medication - No - Lorazepam 1 mg, or Midazolam 7.5 mg
Anesthetic management - Placement of thoracic epidural catheter (T6–T10, depending on the surgical resection); test-dose (Bupivacaine 0.25% with adrenaline 1:200,000), top-up dose (Bupivacaine 0.25% [± 10 ml] with Sufentanil 25 μg, followed by continuous infusion (Bupivacaine 0.125% with Fentanyl 2.5 μg.ml-1) until day 2 postoperative
-Combined with balanced general anesthesia
-Restricted per-operative fluid infusion regime (Ringers lactate 20 ml.kg-1 in the 1st h followed by 6 ml.kg-1.h-1)
-Use of vasopressor drugs as 1st choice for management of mean blood pressure drop > 20% of baseline
-Forced body heating (Bair hugger system and warmed IV fluids)
-Removal of naso-gastric tube before extubation
-Prophylactic use of Odansetron (4 mg) to prevent PONV
- Placement of thoracic epidural conform fast track group, or lower level, or PCA-pump.
-Combined with balanced general anesthesia
-Standard per-operative fluid infusion regime (Ringers lactate 20 ml.kg-1 in the 1st h followed by 10–12 ml.kg-1.h-1)
-Use of extra fluid challenge as 1st choice for management of mean blood pressure drop > 20% below baseline
-Forced body heating (Bair hugger system and warmed IV fluids)
-Removal of naso-gastric tube before extubation
-Use of Odansetron, Dexamethason or Droperidol for PONV management according to attending anesthesiologist
Surgical Management - Minimal invasive incisions/laparoscopy
-Supra-pubic urine catheter
-Infiltration of surgical wounds with Bupivacaine
-No standard use of abdominal drains
- Median laparotomy approach/laparoscopy
-Urine catheter according to attending surgeon
-No infiltration of surgical wounds with local anesthetic drugs
-No standard use of abdominal drains
Early post-operative management - Use of epidural catheter as mentioned before to which Paracetamol 4 × 1 g.d-1 is added
-First oral drinks at 2 h post-surgery, supplemented with CHL liquids, 2 units (Nutridrink®)
-IV infusion of Ringers lactate 1.5 l.d-1
-Mobilization in the evening (>2 h out of bed)
-First semi-solid food intake in the evening
- Epidural or PCA-morphine to which Paracetamol 4 × 1 g.d-1 and/or Diclofenac 3 × 50 mg.d-1 are added
-Small amount of water orally
-IV infusion of Ringers lactate 2.5 l.d-1
-No mobilization scheme
DAY 1 AFTER SURGERY   
Postoperative Management - Oral intake > 2 l (including 4 units CHL liquids)
-Normal diet
-Stop IV fluid administration (leave canulla)
-Start laxative (MgO, 2 × 1 g.d-1)
-Close supra-pubic urine catheter and remove when residue < 50 ml
-Expand mobilization (> 6 h out of bed)
- Diet increased on daily basis
-IV fluid administration (2.5 l.d-1) is continued till adequate oral fluid intake
-Mobilization according to attending surgeon
DAY 2 AFTER SURGERY   
Postoperative Management - Remove epidural add Diclofenac 3 × 50 mg.d-1
-Remove IV cannula
-Continue Paracetamol 4 × 1000 mg and laxative
-Normal diet
-Expand mobilization (> 8 hours)
-Plan discharge
- Epidural removed according to attending anesthesiologist
-Continue as on day 1 untill discharge criteria are fulfilled
DAY 3 AFTER SURGERY - Continue as on day 2 untill discharge criteria are fulfilled Continue as on day 2 untill discharge criteria are fulfilled
  1. CHL: CarboHydrate Loaded, PCA: Patient Controlled Anesthetics, IV: Intra Venous, PONV: PostOperative Nauseaand Vomiting, MgO: Magnesium Oxide