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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

Monitoring equipment should be used in accordance with the Association of Anaesthetists minimum standards of monitoring.^{123,131,185,195}

Children with severe comorbidities who require emergency anaesthesia should be treated in a specialist paediatric centre. However, if transfer is not feasible, the most appropriately experienced senior anaesthetist should provide anaesthesia and support resuscitation and stabilisation.^170,171

A nurse-led sedation service should be supported by an appropriately trained and experienced anaesthetist at all times.⁵²