Search

Locally agreed guidelines and policies should be in place for preoperative management on the day of admission. This should include assessment for risk of venous thromboembolism, pregnancy, premedication and pathways for major surgery (e.g. daycase arthroplasty).^3,9,24

Initial management should follow the adult trauma life support principles with management of airway, breathing and circulation, together with cervical spine stabilisation occurring in parallel rather than in sequence.²² Local guidelines should be followed to ensure that the appropriate tier of trauma call response is made.

Decision support systems for crisis scenarios should be available, for example the Association of Anaesthetists Quick Reference Handbook, advanced life support algorithm, difficult airway guidelines and major haemorrhage protocols.^144,145,146

There should be induction programmes for all new members of staff, including locums. Induction for a locum doctor 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 that the locum is capable of using the equipment in that hospital...

Where possible, ophthalmic surgery should be postponed until after delivery. When this is not possible, guidelines on anaesthetising pregnant patients should be followed (e.g. use of left lateral tilt after 16 weeks of gestation).⁷Local anaesthesia, with or without anxiolytic sedation, is usually preferable to general anaesthesia.