Table 1 Trial protocol for perioperative care of patients undergoing laparotomy.

Preoperative:

Bowel preparation

No routine oral preparation used for colonic resection.*

Fasting guideline

Allowed to drink clear fluids 2 hours before anaesthesia.*

Perioperative:

Epidural analgesia

Placed at thoracic level corresponding to the incision in elective procedures and used intraoperatively.*

Fluid therapy

A preoperative deficit in acute surgery corrected preoperatively, but no routine fluid preload used. Fluid given only to replace measured or calculated deficits (no third space loss) aiming at a body weight increase less than 1 kg. Peroperative blood loss replaced 1:1 with colloids, not exceeding 500 mL more than estimated blood loss. Blood transfusion initiated if blood loss exceeds 20 mL/kg, considering the patient's haematocrit. Vasopressors or reduction of epidural infusion if hypotension.^¤

Temperature control

Warmed fluids if large infusions and upper body air-warming device used. Core temperature measured continuously, aiming at 36 to 37°C.*

Glucose control

Aim: Blood concentration between 5 and 11 mmol/L.

Surgical technique

Shortest possible abdominal incision. No intraabdominal drain, no nasogastric tube unless essential for intraoperative gastric decompression, postoperative ileus prophylaxis or postoperative nutrition.*

Neuromuscular function

Monitored with a nerve stimulator; patients are not extubated before train-of-four ratio is above 0.90.^#

Postoperative:

Pain relief

Epidural analgesia continued for 2 days postoperatively. Paracetamol 4 g daily and a non-steroidal anti-inflammatory drug before discontinuing the epidural analgesia. An opioid is given intravenously if pain score at rest is above 3 on visual analogue scale (0–10).*

Fluid therapy

Oral intake as early as possible, blood loss replaced 1:1 with colloids or blood transfusion according to normal clinical practice. Other deficits replaced with crystalloids in order to keep urine output above 1 mL/kg/hr.^¤