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All institutions where sedation is practised should have a sedation committee. This committee should include key clinical teams using procedural sedation and there should be a nominated clinical lead for sedation. In most institutions, the sedation committee should include an anaesthetist, at least in an advisory capacity.

There should be an appropriately trained theatre team including an on-call consultant or other autonomously practicing anaesthetist 24/7 to provide anaesthesia for emergency head and neck surgery in head and neck cancer centres and in hospitals with an emergency department (ED).⁹

Many head and neck cancer patients 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.¹²

Patients requiring head and neck procedures should be managed by anaesthetists who have had an appropriate level of training in this field and who have acquired the relevant knowledge and skills needed to care for these patients.^41,42

Anaesthetists should be given support and time to familiarise themselves with non-theatre locations and local working arrangements, (e.g. during induction sessions prior to undertaking on-call responsibilities).^13,131

High-risk patients (5% or above mortality risk) or lower-risk patients undergoing high-risk surgery should receive direct consultant anaesthetist and consultant surgeon delivered care in the operating theatre.^2,178

There should be a multidisciplinary team approach to care for pregnant women requiring non-obstetric emergency surgery involving anaesthetists, obstetricians, surgeons, paediatricians and midwives.^184,185,186

Guidelines (e.g. those published by the Association of Paediatric Anaesthetists of Great Britain and Ireland) should be followed for the management of children referred for dental extractions under general anaesthesia.³⁵ Further information on anaesthesia for community dentistry is available in chapter 7.

Anaesthetists providing sedation for dental procedures should follow the guidance on safe sedation published by the Academy of Medical Royal Colleges and Intercollegiate Advisory Committee on Sedation for Dentistry.^36,37 

Vascular anaesthetists should have the appropriate skills and knowledge regarding invasive cardiovascular monitoring, cardioactive or vasoactive drugs, strategies for perioperative organ protection (renal, myocardial and cerebral), the management of major haemorrhage, and the maintenance of normothermia.²⁹