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Equipment available to measure depth of anaesthesia may help to facilitate recovery with fewer postoperative complications.⁵²

Where possible, day surgery is preferable to avoid disrupting normal routines. Guidelines from the Association of Anaesthetists Guidelines on breastfeeding and sedation in breastfeeding women should be followed.⁵⁶

Patients should be supported to breastfeed as normal following surgery with appropriate facilities, including allowing the infant to feed in the perioperative period. There is no requirement to discard breast milk immediately after surgery.⁵³

Multimodal analgesia should be used, including regional anaesthesia. Opioid analgesia can be used if required, but the patient should be given advice regarding observing the infant for signs of excessive drowsiness. Additional advice for prescribing for breastfeeding patients can be found in the guideline from Association of Anaesthetists Guidelines on breastfeeding and sedation in breastfeeding women.⁴⁵

There should be no restriction to treating a patient as a day case based on weight alone. Even patients who are morbidly obese can be safely cared for in expert hands with appropriate resources.^57,58

Anaesthetic review at preassessment is recommended for those patients whose body mass index (BMI) is greater than 40 kg/m² with associated comorbidities. Optimisation is important but should allow safe day surgery. Patients who are super morbidly obese (BMI > 50 kg/m²) need particular care in preoperative assessment and optimisation and may need additional equipment or staffing to be arranged for safe management.^12,54

Patients should be assessed for their risk of sleep apnoea using validated tools such as STOP BANG.⁵ Such tests should be embedded in the preoperative assessment process and should be followed by referral for treatment with continuous positive airway pressure (CPAP). Obstructive sleep apnoea is a multisystem disorder. Thorough preoperative investigation to exclude associated cardiac disorders (Including right-heart strain...

While even patients who are morbidly obese (BMI > 40 kg/m²) can be cared for through a day surgery pathway, it may be inappropriate to operate on them in an isolated environment. In this case, their surgery could be undertaken through a day surgery pathway using the main hospital operating theatres if this environment has the specialist equipment required...

Pathways for patients with additional needs, such as severe anxiety or learning difficulties, should be developed so individualised care can be delivered to minimise anxiety and stress to the patient.

Pathways should be multidisciplinary, starting at preoperative assessment and involving a learning difficulty nurse specialist, if appropriate, the patient’s usual care team, the day surgery team anaesthetist for the list and a surgeon, as appropriate.¹²