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
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.
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).
At least one consultant in each department should take the lead in safeguarding/child protection 59 and undertake training and maintain core level 3 competencies. The lead anaesthetist for safeguarding/child protection should advise on and co-ordinate training within their department, but will not have responsibility for deciding on management of individual clinical cases.
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...
Guidelines, for example 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.34 Further information on anaesthesia for community dentistry is available in chapter 7.
Critical care should be considered for all high-risk patients requiring emergency surgery. As a minimum, patients with an estimated risk of mortality of 5% or higher should be considered for critical care and should be reviewed by a consultant surgeon, consultant anaesthetist and consultant intensivist before surgery.5,130
Consultant or autonomously practising anaesthetists intending to undertake anaesthesia for cardiac surgery should have received training to a higher level in cardiac anaesthesia for a minimum of one year in recognised training centres.43 Those providing critical care for cardiothoracic surgical patients should have received training as described by the Faculty of Intensive Care Medicine (see Cardiothoracic Critical Care, Guidelines...
In isolated units where no anaesthetist or medical emergency team is immediately available, there should be at least one person with advanced life-support training or equivalent.2,9 A clear and agreed pathway should be in place for isolated units to enable the patient to receive appropriate advanced medical care, including intensive care, in the event of it...
All areas in which ophthalmic anaesthesia is performed should have a reliable supply of the medicines required to deliver safe anaesthesia and sedation. Storage arrangements should be such that there is prompt access to them if clinically required, maintains integrity of the medicines, and ensures compliance with safe and secure storage of medicines regulations.31 In addition, anaesthetists and...
