CHAPTER 35 Anesthesia for Daycare Surgeries


Anesthesia has made surgery feasible by providing a relaxed, sedated, pain-free patient. However, surgeries and anesthesia have their complications. Managing the postoperative period is as important as managing the surgery itself. But with the advent of daycare surgeries (DCS), the overall burden of postoperative management and prolonged hospitalization has reduced. This has been made possible due to the emergence of minimally invasive surgeries and newer advances in techniques of anesthesia and analgesia.


  • 1903: Surgeon James Nicoll Glasgow, operated 9000 children almost on daycare basis.

  • 1912: Ralph Waters, USA, who, in his “The Down Town Anaesthesia Clinic,” anesthetized various cases of minor outpatient surgery.

  • 1960: First hospital-based ambulatory unit was developed.

  • 1984: Foundation of the Society for Ambulatory Anaesthesia (SAMBA).


Commonly used terms and abbreviations have been described in Table 35.1.

Table 35.1 Internationally agreed terminology, abbreviations, and definitions as proposed by the International Association for Ambulatory Surgery (World Health Organization 2007)

Table 35.1 Internationally agreed terminology, abbreviations, and definitions as proposed by the International Association for Ambulatory Surgery (World Health Organization 2007)


Synonyms and definitions

Day surgery

  • Ambulatory surgery, same-day surgery, day only

Extended recovery

  • 23 h, overnight stay, single night

  • Treatments requiring an overnight stay before discharge

Short stay

  • Treatments requiring 24–72 h in hospital before discharge

Office-based surgery

  • An operation or procedure carried out in a medical surgery/office or practitioner’s professional premises, which provide appropriately designed and equipped service room(s) for its safe performance


DCS offer various advantages in terms of cost-effectiveness, reduced absenteeism from work, early ambulation, etc. (Table 35.2).

Table 35.2 Advantages of DCS

Table 35.2 Advantages of DCS

Patient benefits

Hospital benefits

  • Less risk of hospital-acquired infections

  • The lesser burden on hospital staff with optimal utilization of human resources

  • Decreased risk of postoperative thromboembolic events

  • Minimally invasive surgeries and regional anesthesia techniques decrease the need for postoperative analgesia

  • Avoids unnecessary occupation of hospital beds

  • Less absenteeism from work

  • Lesser separation anxiety among children

  • Organized scheduling of cases with minimal cancellation

  • The benefit of early return to a familiar environment

  • Lesser burden on family members and caretaker

  • Economically worthwhile

Abbreviation: DCS, daycare surgery.

Patient Selection Criteria

The success of daycare procedures is broadly based on careful selection not only of the patient but also the surgical procedure. Overall safety and postoperative care of the patient is also an important issue that should be kept in mind. Thus, broadly speaking, patient selection is divided into three major domains—surgical, social, and medical.

Surgical Criteria

The advent of advanced minimally invasive surgical procedures has widened the boundaries of ambulatory anesthesia and DCS to a great extent. Surgeries not involving the breach of thoracic/abdominal cavities (except minimally invasive) or not followed by the risk of postoperative hemorrhage can be performed on a daycare basis. Also, the procedure should not require postoperative intravenous fluid therapy or analgesics. Examples of some surgical procedures that can be performed and not limited to have been mentioned in Table 35.3.

Table 35.3 Commonly performed surgeries on a daycare basis

Table 35.3 Commonly performed surgeries on a daycare basis

Orthopedic surgery

  • Diagnostic and therapeutic arthroscopic procedures

  • Anterior cruciate ligament repair

  • Carpal and tarsal tunnel release

  • Minimally invasive hip replacement


  • Adenotonsillectomy

  • Grommet insertion

  • Myringotomy

  • Tympanoplasty

  • Endoscopic sinus surgeries

General surgery

  • Laparoscopic cholecystectomy

  • Ventral hernia repair

  • Gastric fundoplication perianal fistula repair

  • Pilonidal sinus excision


  • Diagnostic laparoscopy and hysteroscopy

  • Laparoscopic tubal ligation

  • Endometrial ablation


  • Vertebroplasty

  • Lumbar microdiscectomy

  • Stereotactic brain biopsy

  • Cranioplasty

Ophthalmic surgery

  • Cataract surgery

  • Squint repair

  • Trabeculectomy

  • Occuloplasty

Dental surgery

  • Tooth extraction

  • Apicectomies

Pediatric surgery

  • Circumcision

  • Inguinal hernia repair

  • Orchiopexy

  • Hydrocele resection


  • Vasectomies

  • Pyeloplasty

Vascular surgery

  • Varicose vein surgery

Social Criteria

A patient should be scheduled for a daycare procedure only after ensuring a safe home envir­onment, a responsible caregiver, convenient transportation, and communication access (e.g., telephone) in case the need arises. All instructions should be discussed verbally and in a written format by both the anesthesiologist as well as the surgeon.

Medical Criteria

Selection criteria should be done, keeping in mind the overall “medical fitness” of the patient. Thorough and well-documented history should be taken. Preanesthetic checkup is, therefore, of paramount importance in making the decision.

Preanesthetic Checkup for Daycare Surgeries

The idea behind preanesthetic evaluation is to screen the patient for any comorbidities and assess the impact of the patient’s fitness on the surgical outcome and perioperative management. Preoperative evaluation prevents needless delays and cancellations. This evaluation should be done based on structured format and can vary from one institution to another. But the following points must be specifically kept in mind while evaluating the patient for DCS:

  1. Age: Despite having higher incidences of comorbidities, DCS in carefully selected geriatric patients offer all the advantages, as discussed above (Table 35.2). Also, there is reduced cognitive impairment and minimal separation from the home environment. Therefore, there is no upper limit of age, but age > 80 years is considered to be associated with higher perioperative risk.

  2. American Society of Anesthesiologists (ASA) status: Performed with ASA status 1 or 2 to ensure early ambulation and discharge.

  3. Comorbidities: Associated comorbidities and their preoperative evaluation are discussed below in this chapter.

Hypertension: Hypertension has a direct relation with increased perioperative adverse cardiac events, for example, myocardial ischemia. However, in the absence of associated end-organ damage, it is advised not to defer surgeries if blood pressure < 180/110 mm Hg.

Ischemic heart disease: History of myocardial infarction within 6 months, angina at rest, or with minimal physical activity, all pose as contraindications to elective surgical procedures. Detailed evaluation along with the assessment of high-risk factors like coexisting diabetes, peripheral vascular disease, poor exercise tolerance (<4 metabolic equivalents or METs) should be done before coming to the decision of whether or not to proceed with the procedure. β-blocker therapy should be continued throughout the procedure.

Asthma/chronic obstructive pulmonary disease (COPD): Asthmatic patients with good exercise tolerance, no recent history of asthma exacerbation/hospitalization, or systemic steroid intake can be posted for ambulatory anesthesia and DCS. Similarly, for COPD, asymptomatic patients without a recent history of smoking (>6–8 weeks) can be considered. However, avoidance of airway manipulation and preference to local/regional anesthesia are always warranted in these patients.

Acute upper respiratory tract infection: Afebrile patients with no features of lower respiratory tract involvement can be considered for regional anesthesia as day cases. It is best to avoid any tracheal manipulation, but if this cannot be avoided and the patient is febrile, then it is better to defer the case.

Obstructive sleep apnea (OSA): It is associated with a very high risk of perioperative adverse events like difficulty in airway handling, fall in oxygen saturation, airway obstruction, hypertension, and cardiac dysrhythmias. Opioids should better be avoided, or dose should be limited. These patients can be considered for DCS, provided the patient tolerates continuous positive airway pressure devices (CPAP) and is efficient in practicing this at home postdischarge.

Diabetes mellitus: Diabetic patients pose no contraindication to DCS unless they have associated comorbidities like autonomic dysfunction, cardiovascular or renal impairment (which can independently cause multiple complications). It is advised to schedule these patients as the first case. Patients should be clearly instructed to omit the morning dose of oral hypoglycemic agents or insulin. Their nil per oral time should be minimized postsurgery.

Renal and hepatic diseases: Patients with severe hepatic disease, a renal disease requiring dialysis, are not candidates for daycare procedures. However, minor procedures like dialysis fistula access can be performed under local/regional anesthesia on a daycare basis.

Fasting Guidelines for Daycare Surgeries

The standard guidelines of fasting, as proposed by ASA, are also followed for various daycare procedures (Table 35.4).

Dec 11, 2022 | Posted by in ANESTHESIA | Comments Off on CHAPTER 35 Anesthesia for Daycare Surgeries

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