1.11 Day surgery

Question 1

Criteria

Medical

Answer 1

Medical

Normally fit and well or well controlled chronic disease

Patients should understand R/B procedure
post op care
and carers

Obesity not absolute c/i

Question 2

Criteria

Soicial

Answer 2

Must be able to be pre op

Responsible adult transport home
oversee 24h

access telephone
advice/emergencies

Accom should be suit
heating / hot water / toilet

Question 3

Organisation consideration periop care day surgery

Answer 3

1 Purpose built area / ward - unit

2 Lead senior clinical (ideal anaes cons w/ spec interest day surgery
- protocol / gl/ clinical governance + training

3 senior nurse in charge day - day running
direct liason lead clinical
rota / governance staff straining

4 rep at trust board level

5 dedicated skill clerical staff

6 day case paeds
facilities provide standard of paed ward

7 adequate resource catering

8 list order
beginning of list to allow recovery

9 clear and concise d.c criteria patients
clinical parameters/ scoring sys

10 Copy d/c summary patient / gp and file dnotes

11 verbal and written advice
driving cooking alcohol contract clinics

Question 4

Anaesthetic considerations

Answer 4

1 Preop assess
optimise conditions - important to success outcome

2 Analgesia
aim for pain free post op period
combo analgesics

3 Consider regional techniques possible + approp
sep d/c criteria
min or no opiate adjunct
lower volume LA

4 PONV
ID high risk patients suitable for modify techqiue
tiva
multi modal 
ivf

5 Standard protocols for certain op eg lap chole
minimise morbidity
allow successful same day d/c

6. G/L prescription of d/c meds
   specfically analgesia