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Patients undergoing lung transplantation may be under the age of 18 years. Anaesthetists must be aware of legislation and good practice guidance relevant to young and vulnerable adults.,^21,27Children undergoing transplantation should be cared for in a paediatric centre.

A minimum of two members of staff should be present (of whom at least one should be a registered practitioner) when there is a patient in the recovery unit who does not fulfil the criteria for discharge to the ward. If this level of staffing cannot be assured, an anaesthetist should stay with the patient until satisfied that the patient...

Patients exhibit extremely wide variation in response to drugs used for sedation. It is difficult to and undesirable to have to manipulate the airway of an unpredictably over-sedated patient during surgery, and so administration of intravenous sedation during ophthalmic surgery should only be undertaken by an anaesthetist whose sole responsibility for the duration of the surgery is to that patient.²

There must be the ability to provide the patient with an appropriate chaperone, as per General Medical Council (GMC) guidance on intimate examinations and chaperones.⁴⁹ When examining a patient, anaesthetists must be sensitive to what the patient may consider as intimate. This could include any examination where it is necessary to touch or even be close to the patient.

Agreed local clinical guidelines should be in use, produced by an appropriately constituted multiprofessional team comprising anaesthetists, specialist nurses, surgeons, critical care clinicians, pharmacists, specialty consultants or autonomously practising anaesthetists and managers. These guidelines should cover at least the following:

• airway management, including follow-up for difficult situations (both plastic surgery and burn reconstructive surgery)⁷⁶
• monitoring of free flaps^47...

Families should be provided with written or web-based resources that provide information specific to anaesthesia before the planned surgery/procedure, and contact details for the preassessment team should be provided in case they have further questions or need to speak directly with their anaesthetist.⁸⁹ The leaflet ‘Information for Teenagers, Children and Parents’ is available from the RCoA website...

Anaesthetists who care for children and young people should be familiar with relevant patient safety issues.⁷⁹

Dedicated, skilled assistance for the anaesthetist should be available in every situation where anaesthesia or sedation is employed.^4,5

There should be an identified group of senior anaesthetists who manage and deliver a comprehensive ophthalmic anaesthesia service, including the use of orbital regional anaesthetic techniques.²

Healthcare workers, including the anaesthetist, must be aware of the local policy for child protection, and they have an obligation to document and report any concerns to a responsible individual.⁴³