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RA-UK recommend that, under certain strict criteria and as defined in RA-UK supervision guidelines, intraoperative patient monitoring may be delegated to a suitably trained health care worker who has been specifically trained in patient monitoring according to Association of Anaesthetists guidelines. This recommendation pertains to awake surgery under peripheral regional anaesthesia but excludes patients undergoing shoulder surgery in the deck...

Thoracic anaesthesia is a ‘key unit of training’ in both the 2010 intermediate level training in anaesthesia³⁴ and in the newer 2021 Curriculum Stage 2.³⁵of training. Trainee anaesthetists should be of appropriate seniority to be able to benefit from this area of training. Stage 3 training of the 2021 Curriculum also requires trainees to be proficient...

Consultant or autonomously practising anaesthetists intending to deliver anaesthesia for thoracic surgery should have received training to a higher level in thoracic anaesthesia. This should be undertaken as a Special Interest Area in Stage 3 training for a period of 3 - 6 months in a recognised training centre.³⁶ Those providing critical care for cardiothoracic surgical patients should...

Anticipated difficulty with anaesthesia should be brought to the attention of the anaesthetist as early as possible before surgery.⁸⁰ This includes planned admission to a critical care unit, the potential need for special skills such as fibre optic intubation, obesity, complex pain problems, a known history of anaesthetic complications or patients with learning disabilities who may require additional resources...

The experience and expertise of the anaesthetist assessing the patient preoperatively should be appropriate for the complexity and level of risk of the patient.⁴⁶ The decision to operate on high risk patients should be made at a senior level, involving surgeons and those who will provide intra and postoperative care.^3,14,33

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 being required.²