Day-case and ambulatory anaesthesia

Meet the patient

A 54-year-old woman, ASA 2, arrives for a laparoscopic cholecystectomy on the day-case list (taught vignette). She has a responsible partner, lives ten minutes from the hospital, and scores three Apfel factors. The plan writes itself — and the fellowship exam wants to hear you write it.^[1]

The two questions that decide every day case are the two juniors forget: is this patient safe to send home alone tonight? and have I built the anaesthetic around waking up comfortable, warm, and not vomiting? Hold those two and the whole pathway slots into place (taught framing).^[5][1]

References10ShowHide

1. [1]Apfel CC, Läärä E, Koivuranta M, et al. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers Anesthesiology, 1999.PMID 10485781
2. [2]Joshi GP, Ankichetty SP, Gan TJ, Chung F Society for Ambulatory Anesthesia consensus statement on preoperative selection of adult patients with obstructive sleep apnea scheduled for ambulatory surgery. Anesth Analg, 2012.PMID 22886843
3. [3]Pandit JJ, Andrade J, Bogod DG, et al. 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors Br J Anaesth, 2014.PMID 25204697
4. [4]Neal JM, Barrington MJ, Fettiplace MR, et al. The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity: Executive Summary 2017 Reg Anesth Pain Med, 2018.PMID 29356773
5. [5]Chung F, Chan VW, Ong D A post-anesthetic discharge scoring system for home readiness after ambulatory surgery. J Clin Anesth, 1995.PMID 8534468
6. [6]Chung F, Yegneswaran B, Liao P, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology, 2008.PMID 18431116
7. [7]Fuchs-Buder T, Romero CS, Lewald H, et al. Peri-operative management of neuromuscular blockade: A guideline from the European Society of Anaesthesiology and Intensive Care. Eur J Anaesthesiol, 2023.PMID 36377554
8. [8]American Society of Anesthesiologists Committee on Standards and Practice Parameters Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures: An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Anesthesiology, 2017.PMID 28045707
9. [9]Gan TJ, Belani KG, Bergese S, Chung F, et al. Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting. Anesth Analg, 2020.PMID 32467512
10. [10]Quaye A, Tsafnat T, Richard JM, et al. Post-operative pain control in patients on buprenorphine or methadone for opioid use disorder. J Opioid Manag, 2024.PMID 39017615