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Many patients with head and neck cancer have significant comorbidities that may require optimisation prior to surgery. There should be a lead anaesthetist for preoperative assessment who works closely with an appropriate preoperative assessment team.¹⁴

Where possible, surgery should be postponed until after delivery. If this is not possible, for example in cases of head and neck cancer, a multidisciplinary team approach is highly recommended, typically involving anaesthetists, surgeons, oncologists, obstetricians, midwives and paediatricians and, in cases of thyroid malignancy, endocrinologists.

A multidisciplinary team may be required, which this may include plastic, vascular or neurosurgical surgeons for complex head and neck surgery. Anaesthetists may be required to attend multidisciplinary team meetings preoperatively. Attendance should be included in their job plan if it forms a regular commitment.

All anaesthetists completing the 2021 RCoA curriculum should be able to deliver a range of safe and effective central or peripheral regional anaesthetic techniques to cover the upper and lower limb, chest and abdominal wall independently.⁴⁷

All anaesthetists should have access to adequate time, funding and facilities to undertake training in, and update or advance their regional anaesthesia knowledge and skills relevant to their clinical practice.^2,18

Anaesthetists should facilitate surgery within 36 hours of a hip fracture.⁵¹ Surgery should be delayed only if the benefits of additional medical treatment outweigh the risks of delaying surgery. The risks of delay associated with pain and immobility contribute to poor outcomes to a far greater extent than correction of an abnormality to a particular numerical value.⁴⁵

There should be multidisciplinary input for the preoperative assessment of high risk patients such as patients with cognitive disorders, chronic kidney disease, diabetes mellitus and ischaemic heart disease.^50,65 The anaesthetist should be involved in preoperative optimisation and prehabilitation plans.^60,62

All anaesthetists who provide elective or emergency care for infants, children or young adults should have training in advanced life support that covers their expected range of clinical practice and responsibilities.^52,53 These competencies should be maintained by annual training that are ideally multidisciplinary and scenario based.⁵⁴

Intermediate level training as set out in the RCoA 2010 Curriculum⁴¹should be an essential criterion and higher level training a desirable criterion in the person specification for a consultant or autonomously practising anaesthetist with ophthalmic anaesthetic sessions in the job plan. For candidates who are trained on the RCoA 2021 Curriculum, the special interest area in ophthalmic anaesthesia...