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High-risk surgical patients should have their expected risk of death estimated and documented prior to intervention, with due adjustments made in planning the urgency of care, seniority of staff involved and postoperative care.^{62,63,64,65,66,67,68,69}

Anaesthetists should be familiar with the specific needs of patients with cancer, including the following:

• the adverse effects of high concentrations of oxygen in the presence of some antineoplastic agents, for example bleomycin, and should adjust their technique accordingly.[i]^,[ii] Recent evidence confirms the association between unnecessarily high intraoperative fraction of inspired oxygen and increased risk of...

Local protocols should determine the grade, experience and competency-based training of the nurse undertaking preoperative assessments and accompanying the patient to the operating department.⁹ For 1,000 patients, the following minimum staffing is required:¹⁰

• 0.6 registered nurses
• 0.3 healthcare assistants

This staffing to patient ratio is based on 80% of patients as day cases and 20% as inpatients assuming...

Trainees should have an appropriate balance between thoracic, cardiac and ICU training based on their individual requirements.⁶³

Patients should have easy access to reliable sources of information (web based and written) for joint replacement surgery. Options for anaesthesia and analgesia, and potential benefits and risks of each option should be discussed with patients to support shared decision making.^46,113

All hospitals that provide surgery for children and young people should have clear operational policies regarding who can anaesthetise children for elective and emergency surgery. This will be based on continuing clinical experience, the age of the child, the complexity of surgery and the presence of any comorbidities.^8,15

The time allocation for staffing of the preoperative service with nurses, AAs, operating department practitioners (ODPs), healthcare assistants and pharmacy staff should be based on local data that reflect surgical case mix, acuity of patients and high risk daycase workload.^48,49