• Paediatric daycase
    • Advantages
      • Better sleep pattern preservation
      • Less nocturnal enuresis
      • Economic benefits
      • Avoidance of HAI
      • Can be screened prior to admission
      • Do not need to be seen routinely by anaesthetist prior to admission on the day
    • Selection criteria exclusions
      • Patient
        • Former preterm infant <50 weeks pre conceptual age
        • Inadequately controlled systemic disease
        • Acute viral/bacterial infection
          • Defer for 4/52 if LRTI
          • Defer 2/52 for URTI
          • Seems reasonable to proceed with mild URTI symptoms
        • Complex congenital heart disease
        • Uninvestigated murmur
        • DM
        • SCD
        • Sleep apnoea
      • Procedure
        • Inexperienced surgeon/anaesthetist
        • Prolongued procedure (>1hr)
        • Risk of post-op haemorrhage
        • Body cavity surgery
        • Difficult airway
        • MH
        • Post-op pain unlikely to be controlled with simple oral analgesics
      • Family
        • Lack of parenteral support
        • No telephone
        • Lack of transport facilities
        • Long distance from hospital
    • Discharge criteria
      • Ok to allow home if not drinking if had peri-operative hydration
      • Ok if hasn't passed urine (unless surgically indicated eg penile surgery)
      • Commonest causes for not going one are PONV and pain
      • Day activity should be audited
    • Other issues
      • Airway
        • LMA has many advantages
      • Fluids
        • Reduces PONV
      • Analgesia
        • Local anaesthesia
          • Caudal
          • Peripheral nerve blocks
            • Penile
            • Ilioinguinal-iliohypogastric blocks
            • Greater auricular nerve block
          • Topical
          • Wound infiltration
        • NSAIDs and paracetamol
          • 1mg/kg diclofenac pr
          • 5-10mg/kg ibuprofen qds
          • 20mg/kg loading IV paracetamol
          • 15mg/kg paracetamol at d/c
        • Opiates
          • 1mg/kg codeine qds
          • Fentanyl 1-2μcg/kg
          • Avoid long acting opiates
      • PONV
        • Ondansetron 0.1mg/kg
        • Dexamethasone 0.1 mg/kg
    • Anaesthetic management
      • Premedication
        • Oral midazolam 0.5mg/kg ok for day surgery
        • EMLA and Ametop
        • IM ketamine 2mg/kg may be helpful in very unco-operative children
      • Induction
        • Parents can be present
        • Consider inhalational induction if IV access hard
        • Sevoflurane for gas induction
        • Transparent face masks
        • Lignocaine 0.2mg/kg prior to propofol
        • Propofol up to 4mg/kg
      • Maintenance
        • N₂O, O₂ and volatile
        • Less experience of TIVA but may be useful in strabismus where there is high risk of PONV
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/3/5/134.full.pdf?sid=d825959d-b52f-4ca1-81f1-a08927d1595b