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Selection criteria for Day Case Surgery |
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Surgical ¨ Estimated operation time< 1 hour ¨ Minimal blood loss / morbidity / complications ¨ Unlikely to result in severe post-operative pain or nausea ¨ Unlikely to cause loss of independence or toilet function
Social ¨ Patient must agree to day surgery ¨ <1 hour travel time from hospital ¨ Telephone available in the home ¨ Have capable adult in the home and look after them on the night after surgery
Medical—few absolute contraindications ¨ No major pre-existing disability ¨ Physiologically under 70 years of age— although age is no barrier ¨ Able to climb a flight of stairs without stopping ¨ Acceptable BMI . Max BMI = 36 ¨ Exclude patients with: Diastolic BP> 100mmHg Symptomatic cardiac failure Severe gastric reflux on lying flat, unresponsive to treatment Pregnancy (unless for VTOP) Multiple sclerosis
NB Patients with well controlled asthma, mild angina, NIDDM and patients who had an uncomplicated myocardial infarction more than six months previous and are currently well, would usually be suitable.
Anaesthetic Discuss with anaesthetist if: ¨ History of significant anaesthetic problems, e.g. difficult intubations ¨ Personal or family history of malignant hyperpyrexia or myopathies
MEDICATIONS As a general rule all essential medications should be continued on the day of surgery especially CARDIAC, ANTIHYPERTENSIVES, ANTICONVULSANT medication. Also continue RANITIDINE, OMEPRAZOLE and similar class of drugs. DIABETIC TABLETS— omit all on day of surgery, restart once eating. PSYCHIATRIC DRUGS— continue on day of surgery, unless taking MAOI’s— check with anaesthetist— need to stop for 2 weeks before. LITHIUM— stop the day before. ASPIRIN— stop 2 weeks pre-operatively if for urological surgery WARFARIN— a contraindication to day surgery.
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