Search

The lead obstetric anaesthetist should ensure representation of the anaesthetic department at multidisciplinary meetings for service planning and governance purposes, including labour ward forum, risk management groups and incident reviews.^22,24

Non-specialist tertiary paediatric centres should have a multidisciplinary committee for paediatric care to formulate and review provision. This committee should involve anaesthetists, paediatricians, surgeons, emergency department representatives, senior children’s nurses, managers and other professionals, such as paediatric pharmacists. In some hospitals, this will also include critical care physicians.

Parents and carers should be involved throughout the care process. With the agreement of the anaesthetist in charge of the case on the day, they should be able to accompany children to the anaesthetic room, remain present for induction of anaesthesia and be able to gain easy access to the recovery area. In special circumstances, such as with some small...

Anaesthesia may be required for radiotherapy, to facilitate patient positioning and to alleviate pain. Owing to the unique nature of the procedures involved in radiotherapy, the remoteness of the location and the lack of direct access to the patient, only appropriately experienced anaesthetists familiar with the therapy should embark on anaesthesia for these patients.⁷³

There should be a system in place for antenatal anaesthetic review by a senior anaesthetist for women who are morbidly obese.¹⁰³ Assessment should be arranged to ensure that timely delivery planning can take place.¹⁰⁴

In a true emergency situation involving a child requiring urgent neurosurgery for a deteriorating condition admitted to an ‘adult only’ neurosurgical service, the most appropriate surgeon, anaesthetist and intensivist available would be expected to provide lifesaving care, including emergency resuscitation and surgery.²⁸

Local guidance should be developed for the intrahospital transfer of neuroscience patients, based on guidance from the Neuroanaesthesia and Neurocritical Care Society (NACCS), the Association of Anaesthetists and the Intensive Care Society.^41,42,43

The standard of monitoring in the operating theatre should allow the conduct of safe anaesthesia for surgery as detailed by the Association of Anaesthetists standards of monitoring.⁴ Quantitative neuromuscular monitoring is beneficial during Robotic assisted thoracic surgery (RATS) to avoid inadvertent patient movement and injury.

All thoracic units should have regular morbidity and mortality meetings. These meetings should be provided with a list of patients to discuss in advance, an attendance register, and minutes with learning points. Consultants or autonomously practising anaesthetists should attend these meetings and they should be included in job plans. Trainees should be encouraged to attend during their attachments.

Anaesthesia departments should make arrangements to allow anaesthetists working solo during long surgical procedures or on overrunning lists to be relieved by a colleague or AA for meal and comfort breaks.^116,117,112