# Day-care Anaesthesia

> Day-care anaesthesia for Anaesthesia Technology: patient selection, Apfel PONV scoring, short-acting agents, fast-tracking and discharge criteria.

- Canonical URL: https://prepelephant.com/topics/allied/anaesthesia-technology/day-care-anaesthesia-at
- Exam / course: Allied Health · Subject: Anaesthesia Technology
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "Day-care Anaesthesia", PrepElephant, https://prepelephant.com/topics/allied/anaesthesia-technology/day-care-anaesthesia-at

## Direct answer

Day-care (ambulatory) anaesthesia is built for same-day discharge, so every choice is filtered through recovery speed: selection favours ASA I-II patients (stable III), body mass index generally under 35-40, above six months of age (ex-prematures until about 60 weeks post-conceptual age because of apnoea risk), and procedures under about two hours with minimal blood loss and pain controllable by oral analgesics and local or regional blocks. Technique prefers short-acting agents — propofol, sevoflurane or desflurane, fentanyl or remifentanil in small doses, ondansetron 4 mg and dexamethasone 4-8 mg for the post-operative-nausea-vomiting risk scored by Apfel criteria (female, non-smoker, previous PONV or motion sickness, post-operative opioids — each factor adds roughly 20% risk from a 10% baseline). Discharge follows the PADS-type criteria: stable vitals, controlled pain and bleeding, tolerated oral intake, a responsible adult escort, and written instructions covering the 24 hours in which driving, alcohol and signing legal documents are prohibited.

## What you must remember

- **Selection gates:** ASA I-II (or stable III), BMI commonly under 35-40 kg/m², age over six months (with the 60-week post-conceptual age rule for ex-preterm infants), controlled systemic disease, a cooperative patient with an adult escort at home.
- **Procedure gates:** duration roughly under two hours, minimal expected blood loss and third-space loss, pain manageable with oral multimodal analgesia plus wound infiltration or a peripheral nerve block, no significant post-operative nausea-vomiting expectation.
- **Apfel score arithmetic:** female sex, non-smoking, previous PONV or motion sickness, and anticipated post-operative opioids — 0 factors ≈ 10% risk, 1 ≈ 20%, 2 ≈ 40%, 3 ≈ 60%, 4 ≈ 80%; two or more factors justify multimodal prophylaxis.
- **Anaesthetic preferences:** propofol induction and maintenance (PONV-sparing), sevoflurane or desflurane for rapid emergence, short-acting opioids titrated, and regional blocks or wound infiltration to spare opioids.
- **Discharge criteria (PADS-type):** stable vital signs for at least an hour, no active bleeding, pain controlled on oral analgesia, tolerating oral fluids, voiding (no longer universal), accompanied by a responsible adult, given written and verbal instructions.
- **Post-discharge rules for the patient:** no driving, alcohol, operating machinery, signing legal documents, or sole care of dependants for 24 hours (commonly quoted up to 48) — a fixed viva answer.
- **Technician's role:** pre-assessment screening, morning sequence efficiency, block trolley readiness for the fast-track pathway, and escort documentation before discharge.

## A day list that shows the discipline

A 32-year-old non-smoking woman for diagnostic laparoscopy exemplifies the calculus. Apfel score: female, non-smoker, expected opioids — 3 factors, roughly 60% PONV risk without prophylaxis, so the anaesthetic is designed around it: propofol TIVA rather than volatile, ondansetron 4 mg and dexamethasone 8 mg at induction, fentanyl titrated to 100 microgram total with paracetamol 1 g and infiltration of the port sites, and a total intravenous technique that doubles as antiemetic. The operation finishes in forty minutes; she bypasses stage-one recovery to a chair — fast-tracking — because she is awake, comfortable, haemodynamically stable and not nauseated, the four conditions scored formally before the move.

The discharge process is a checklist the technician assembles: vitals stable for an hour, pain 3 or less out of 10 on oral analgesia, sips tolerated, dressed and walking unaided, husband present as escort, and the printed instruction sheet handed over with the 24-hour prohibitions read aloud. What day-care philosophy really tests is the willingness to trade pharmacological comfort for economy: every long-acting drug deferred today is an extra hour in the hospital tonight, and the failed discharge (usually pain or vomiting) is traced in audit to a skipped prophylaxis step, not to bad luck.

## Where students slip

Two confusions recur. First, fasting and selection rules are quoted absolutely: the six-month age floor and 60-week post-conceptual rule exist for apnoea monitoring reasons, while voiding before discharge has been relaxed in most modern guidelines — candidates who answer "must void before discharge always" lose the mark to "no longer mandatory in most protocols". Second, the Apfel factors are listed incompletely; the exam expects all four with the 20% step-up per factor, and the phrase "each risk factor roughly doubles" is acceptable shorthand at low counts. The last trap is treating PONV as a comfort issue: in day-care it is the leading cause of unplanned overnight admission and readmission, which is why prophylaxis strategy, not treatment, is the examined answer.

## Frequently asked questions

### Which patients are suitable for day-care anaesthesia?

ASA I-II or stable III, BMI commonly under 35-40, age above six months (ex-prematures until about 60 weeks post-conceptual age), undergoing short procedures with minimal blood loss and orally controllable pain, with a responsible adult escort.

### What is the Apfel score and how is it used?

Four PONV risk factors — female sex, non-smoker, previous PONV or motion sickness, post-operative opioids — stratifying risk from about 10% with none to about 80% with all four; two or more triggers combination antiemetic prophylaxis.

### Why is propofol preferred in day-care anaesthesia?

It is rapidly cleared, leaves minimal hangover, and is intrinsically antiemetic, so total intravenous anaesthesia with propofol reduces PONV and speeds recovery-room discharge and fast-tracking.

### What are the standard discharge criteria after day surgery?

Stable vital signs, controlled pain on oral analgesia, no bleeding, tolerated oral fluids, safe walking, a responsible adult escort, and written instructions — the PADS framework; mandatory voiding is no longer universal.

### What must patients avoid after day-care anaesthesia?

Driving, alcohol, operating machinery, making legal or financial decisions, and being solely responsible for dependants for at least 24 hours (some units advise 48), because psychomotor impairment outlasts subjective recovery.