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Fellowship posts should be identified to allow additional training for those who wish to follow a career in cardiac or thoracic anaesthesia to help ensure there are adequate numbers of skilled anaesthetists in the specialty. These should be suitable for trainees who wish to take time out of training programmes, or for those who are post certificate of completion of...

Anaesthetists with a job plan that includes obstetric anaesthesia must demonstrate ongoing continuing education in obstetric anaesthesia, and continuing professional development as needed for this aspect of their work.¹⁰⁴ Hospitals have a responsibility to enable this with local teaching where appropriate, and by facilitating access to other education and training.^96,105,106

Elderly patients presenting for elective surgery frequently have pre-existing comorbidities that require careful review and perioperative planning. As such, the preassessment service for elective patients should be consultant led, ideally by anaesthetists with an interest in, and appropriate experience in, delivering anaesthetic care to orthopaedic patients.^{12, 14}

All anaesthetists should be fully familiarised with all remote areas of anaesthetic provision, e.g. as part of their induction process, prior to undertaking anaesthetic procedures in that location.⁵⁶ This should include familiarisation with the layout of the hospital and the location of emergency equipment and drugs, access to guidelines and protocols, information on how to summon support/assistance, and assurance...

In order to maintain the necessary repertoire of skills, consultant anaesthetists and SAS doctors providing a head and neck service should have a regular commitment to the specialty, and adequate time should be made available for them to participate in a range of relevant continuing medical education activities, including simulation, human factors and team training.^7,43,44

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.^4,5,19

To maintain the necessary repertoire of skills, consultant anaesthetists and SAS doctors providing a head and neck service should have a regular commitment to the specialty. Adequate time should be made available for them to participate in a range of relevant continuing medical education activities, including simulation, human factors and team training.^7,43,44 

Appropriately trained healthcare workers monitoring patients who have undergone regional anaesthesia should be specifically trained with their competencies clearly defined according to the Association of Anaesthetists’ requirements for post-anaesthesia care unit (PACU) recovery nursing.²⁹ This individual should be able to recognise symptoms and signs of local anaesthetic toxicity.²⁵

Those who refuse transfusion of blood or blood products, whether because of adherence to the Jehovah’s Witness faith or for other reasons, should be identified early in the antenatal period. They should meet with an anaesthetist to discuss their specific wishes and should receive information about the potential risks associated with their decision to ensure informed consent process.^118...

Preoperative assessment, optimisation and shared decision making in patients with multiple comorbidities, frailty or cognitive impairment require a cross specialty approach involving anaesthetists, surgeons, geriatricians, pharmacists and allied health professionals. Liaison with a clinical pharmacist in the perioperative period will enable optimisation of medicines and improved management of the patients’ non-surgical comorbidities during this time. The development of such teams...