Perioperative Management Protocol for Surgical Patients

Patients are administered 400 ml/50 g carbohydrate pre-surgery drink, premedicated and anesthetized according to the standardized protocol which defines: perioperative medication, fluid therapy, hemodynamic goals and management, diuresis, core temperature, transfusion threshold, and postoperative nausea, and vomiting prevention. The protocol also defines analgesia corresponding with randomization (including a detailed standard of care for thoracic epidural analgesia). All the data are recorded including the length of anesthesia and surgery, and a brief description of the type of surgery and observed radicality.
Postoperative care is standardized including postoperative analgesia corresponding with randomization, hemodynamic optimization, fluid therapy and transfusions, glycemic control, and postoperative nausea and vomiting management.
A detailed description of perioperative and postoperative management in all three arms of the study is displayed in Fig. 2. The patients with insufficient pain relief on the protocol medication will be provided rescue multimodal analgesia with a strong opioid and will be excluded from the final analysis of the CTCs.Fig. 2

Detailed protocol of perioperative management

All the data are recorded to the patient´s electronic CRF, using academic cloud operated software ClinData (https://clindata.imtm.cz), including pain intensity (using the Numerical Rating Scale) and sedation (using the Richmond Agitation-Sedation Scale), adverse effects and complications directly associated with PA, postoperative nausea and vomiting, core temperature, duration of postoperative ileus, laboratory tests, and cognitive function evaluation.