New draft for member consultation: Day Case Surgery.

Day case surgery guideline is in its final draft stage and comments are invited from members. Please read the draft and submit comments to workingparties@aagbi.org

All comments submitted will be considered before a final version is brought before the AAGBI Board for approval. The closing date for comment submission is 5pm on Wednesday 13 June 2018.

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Day Case Guidelines - Member comments.pdf296.33 KB

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Comments

Day Case Guideline comment

I'd echo the comment below with respect to driving advice and isoflurane post day case surgery. In the  editorial in Anaesthesia 2017, 72, 675–685 by Powell et al. there didn't seem to be enough evidence to recommend a driving ban for four days after isoflurane anaesthesia unless there is more evidence that has come out recently. The RCA advice to patients 'When can I drive after the operation?' seems to have a fair statement and it might be good to have similar advice.

Analgesia

 

Page 15 - The use of pre-packed analgesics depends on local trust protocols regarding what drugs are supplied. It is not uncommon for some to NOT provide paracetamol or Ibubrofen. Given this I feel it should be recommended instead that patients are advised to have a supply of simple analgesics at home and that units should check this is the case and provide written advice.

 

Day surgery guidelines

I have 2comments

1.I suggest adding to this section - Nursing staff should follow strict criteria to enable safe mobilisation after spinal anaesthesia and lower limb regional anaesthesia. These include return of sensation to the peri-anal area (S4-5), plantar flexion of the foot at pre-operative levels of strength, and return of proprioception in the big toe. This may be affected by any supplementary local anaesthetic infiltration or regional anaesthesia used to provide longer acting anaesthesia at the operative site such as ilioinguinal nerve block or infiltration which causes leg weakness due to femoral nerve block in approximately 1 in 10 patients for several hours.  A straight leg raise test can identify this and be used as a test prior to mobilisation ( ref Leg weakness is a complication of  ilioinguinal nerve in children .  AK Lipp,J Woodcock,B Hensman and K Wilkinson. Br J Anaesthesia 2004;92:273-4.

2. Comment re Isoflurane and impaired driving ability for 4 days should be referenced as this could have medicolegal implications and will cause concerns for all users of isoflurane , not just in day surgery.