Which of the following is a CONTRAINDICATION to day-care (outpatient) surgery under general anaesthesia?
- A Well-controlled type 2 diabetes mellitus on oral agents
- B ASA III patient with stable ischaemic heart disease on beta-blockers
- C Morbid obesity with BMI 42 and obstructive sleep apnoea requiring CPAP at home ✓
- D Age >60 years with mild osteoarthritis
Explanation
Morbid obesity combined with obstructive sleep apnoea (OSA) requiring CPAP is a relative contraindication to day-care surgery because: (1) OSA patients have difficult airways; (2) postoperative opioid analgesics further depress upper airway tone; (3) arousal responses are blunted post-anaesthesia; (4) monitoring capability for apnoeic episodes is limited at home. These patients require overnight monitoring in a facility equipped for continuous SpO2 monitoring. Well-controlled T2DM on oral agents and stable cardiac disease with good exercise tolerance are acceptable for day-care. Age alone is not a contraindication.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
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