Perioperative Care of Patients Selected for Day Stay Procedures

Overview:

Day stay procedures aim to discharge patients on day of admission to their place of residence
Selection of appropriate patients for day surgery is ultimately the responsibility of the anaesthetist

Patients Selection

Should be:

ASA 1 or 2
Medically stable ASA 3 or 4 may be appropriate.
Comorbidities
- OSA
  - Postoperative opioid should be minimised
  - DC analgesia should not include opioids
Procedure
- Minimal risk of post-operative haemorrhage
- Minimal risk of post-operative airway compromise
- Amenable to outpatient analgesia
- Post-operative care manageable by patient and a responsible adult
- Permit a rapid return to normal fluid and food intake
Discharge planning should occur prior to admission, and be confirmed on admission
Able to seek medical attention
⩽1 hour from appropriate help.

Requirements:

Stable vital signs
Return to pre-anaesthesia levels of:
- Conscious state
- Mobility
Nausea and vomiting controlled
Aanalgesia adequate
Passing urine
For those at risk of urinary retention.
Discharge instructions
- Eating
- Drinking
- Follow-up plan
- Advice given as to when to resume driving, decision making
Oral intake tolerated
Parent or guardian
- Responsible individual available to supervise
  - Not always feasible
- Ready access to telephone
- Have a transport vehicle
  Private car, not a taxi driver.
Surgical requirements
e.g. Haemostasis.