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Children with severe comorbidity 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, as part of the multidisciplinary team.^124,125

Preoperative assessment of patients, especially those at very high risk, can benefit from a team approach involving cross specialty advice from anaesthetists, surgeons and intensivists. Early consultation with appropriate medical specialties should occur for appropriate conditions, e.g. acute kidney injury, diabetes mellitus and ischaemic heart disease.¹⁴

Following admission and prior to undergoing a procedure that requires general or regional anaesthesia, all patients should have a preoperative visit by an anaesthetist or suitably trained assistant, ideally a person directly involved with the administration of the anaesthetic.⁵ This should be done to confirm earlier findings or, in the case of the emergency admission, initiate preoperative anaesthetic assessment and care.

Anaesthetists should be involved in audit and quality improvement cycles, preferably using a ‘rapid cycle’ quality improvement approach. This approach benchmarks standards of care, and may be an effective change driver. It is also an excellent way of providing evidence of good practice as defined by the GMC, and mapping the contribution that individuals make to any service within their...

The emergency anaesthesia team should be led by a consultant anaesthetist and include all medical and other healthcare professionals involved in the delivery of anaesthesia for emergency surgery.^13,43 Part of this role should include liaison with other departments such as radiology, medicine and emergency departments (ED).

Clinical governance is the responsibility of individual institutions, and should follow the same principles that apply to medically qualified anaesthetists, ensuring:¹⁴

• training that is appropriately focused and resourced
• supervision and support in keeping with practitioners’ needs and practice responsibilities
• practice centred audit and review processes.

Many ophthalmic patients have significant comorbidities that may require optimisation and co-ordination prior to surgery. There should be a lead anaesthetist (with an appropriate number of programmed activities in their job plan and appropriate secretarial support) for preoperative assessment, who works closely with an appropriately trained preoperative assessment team.^6,7

Where burn services are providing a Burn Centre level of care, there should be a 24/7 rostered availability of ST3 or above specialty registrars or appropriately experienced staff grade, associate specialist and specialty (SAS) doctors and emergency consultants. In Burn Centres that provide paediatric services, there should be a 24-hour rostered availability of consultant paediatric anaesthetists.¹¹

Children currently transition to adult congenital heart disease services at the age of 16–18 years, although transition services are integrated into the care pathway from age 12 years. Anaesthetists should be aware of legislation and good practice guidance relevant to young and vulnerable adults.^45,51