Guidelines for day‐case surgery 2019

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Abstract

Guidelines are presented for the organisational and clinical management of anaesthesia for day-case surgery in adults and children. The advice presented is based on previously published recommendations, clinical studies and expert opinion.

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Most cited references 26

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Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology.

Ian Smith, Peter Kranke, Isabelle Murat … (2011)

This guideline aims to provide an overview of the present knowledge on aspects of perioperative fasting with assessment of the quality of the evidence. A systematic search was conducted in electronic databases to identify trials published between 1950 and late 2009 concerned with preoperative fasting, early resumption of oral intake and the effects of oral carbohydrate mixtures on gastric emptying and postoperative recovery. One study on preoperative fasting which had not been included in previous reviews and a further 13 studies published since the most recent review were identified. The searches also identified 20 potentially relevant studies of oral carbohydrates and 53 on early resumption of oral intake. Publications were classified in terms of their evidence level, scientific validity and clinical relevance. The Scottish Intercollegiate Guidelines Network scoring system for assessing level of evidence and grade of recommendations was used. The key recommendations are that adults and children should be encouraged to drink clear fluids up to 2 h before elective surgery (including caesarean section) and all but one member of the guidelines group consider that tea or coffee with milk added (up to about one fifth of the total volume) are still clear fluids. Solid food should be prohibited for 6 h before elective surgery in adults and children, although patients should not have their operation cancelled or delayed just because they are chewing gum, sucking a boiled sweet or smoking immediately prior to induction of anaesthesia. These recommendations also apply to patients with obesity, gastro-oesophageal reflux and diabetes and pregnant women not in labour. There is insufficient evidence to recommend the routine use of antacids, metoclopramide or H2-receptor antagonists before elective surgery in non-obstetric patients, but an H2-receptor antagonist should be given before elective caesarean section, with an intravenous H2-receptor antagonist given prior to emergency caesarean section, supplemented with 30 ml of 0.3 mol l(-1) sodium citrate if general anaesthesia is planned. Infants should be fed before elective surgery. Breast milk is safe up to 4 h and other milks up to 6 h. Thereafter, clear fluids should be given as in adults. The guidelines also consider the safety and possible benefits of preoperative carbohydrates and offer advice on the postoperative resumption of oral intake.

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International consensus statement on the peri-operative management of anaemia and iron deficiency.

M Muñoz, A Acheson, M Auerbach … (2017)

Despite current recommendations on the management of pre-operative anaemia, there is no pragmatic guidance for the diagnosis and management of anaemia and iron deficiency in surgical patients. A number of experienced researchers and clinicians took part in an expert workshop and developed the following consensus statement. After presentation of our own research data and local policies and procedures, appropriate relevant literature was reviewed and discussed. We developed a series of best-practice and evidence-based statements to advise on patient care with respect to anaemia and iron deficiency in the peri-operative period. These statements include: a diagnostic approach for anaemia and iron deficiency in surgical patients; identification of patients appropriate for treatment; and advice on practical management and follow-up. We urge anaesthetists and peri-operative physicians to embrace these recommendations, and hospital administrators to enable implementation of these concepts by allocating adequate resources.

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Peri-operative management of the obese surgical patient 2015: Association of Anaesthetists of Great Britain and Ireland Society for Obesity and Bariatric Anaesthesia.

C E Nightingale, M Margarson, Aiden Shearer … (2015)

Guidelines are presented for the organisational and clinical peri-operative management of anaesthesia and surgery for patients who are obese, along with a summary of the problems that obesity may cause peri-operatively. The advice presented is based on previously published advice, clinical studies and expert opinion.

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Journal

Title: Anaesthesia

Abbreviated Title: Anaesthesia

Publisher: Wiley

ISSN (Print): 0003-2409

ISSN (Electronic): 1365-2044

Publication date Created: April 08 2019

Publication date (Electronic): April 08 2019

Affiliations

[1 ]Department of Anaesthesia Guy’s and St Thomas’ NHS Foundation Trust Chair of Working Party, Association of Anaesthetists LondonUK

[2 ]Department of Anaesthesia Royal Wolverhampton Hospitals NHS Trust Elected Member, British Association of Day Surgery WolverhamptonUK

[3 ]Department of Anaesthesia Calderdale and Huddersfield NHS Foundation Trust Elected Member, Association of Paediatric Anaesthetists of Great Britain and Ireland HuddersfieldUK

[4 ]Department of Anaesthesia Leeds Teaching Hospitals NHS Trust Elected Member, Association of Paediatric Anaesthetists of Great Britain and Ireland LeedsUK

[5 ]Department of Anaesthesia Ninewells Hospital Elected Member Trainee Committee, Association of Anaesthetists DundeeScotland

[6 ]Department of Anaesthesia Norfolk and Norwich University Hospital Elected Member, British Association of Day Surgery Norwich UK

[7 ]Department of Anaesthesia Torbay and South Devon NHS Foundation Trust Elected Member, British Association of Day Surgery TorbayUK

[8 ]Department of Anaesthesia Rotherham NHS Foundation Trust Elected Member, British Association of Day Surgery RotherhamUK

[9 ]Department of Anaesthesia Chelsea and Westminster NHS Foundation Trust SAS Committee, Association of Anaesthetists LondonUK

[10 ]Department of Anaesthesia, Torbay and South Devon NHS Foundation Trust President, British Association of Day Surgery Torbay UK

Article

DOI: 10.1111/anae.14639

PubMed ID: 30963557

SO-VID: 2e588894-8583-4ced-ad53-4781ca5d4575

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http://creativecommons.org/licenses/by-nc-nd/4.0/

http://doi.wiley.com/10.1002/tdm_license_1.1

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Guidelines for day‐case surgery 2019 : Guidelines from the Association of Anaesthetists and the British Association of Day Surgery

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Most cited references 26

Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology.

International consensus statement on the peri-operative management of anaemia and iron deficiency.

Peri-operative management of the obese surgical patient 2015: Association of Anaesthetists of Great Britain and Ireland Society for Obesity and Bariatric Anaesthesia.

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