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In each hospital providing neuroanaesthesia, a neuroanaesthetist should be appointed as the clinical lead (see Glossary) to manage service delivery. Adequate time for this role should be included in the lead’s job plan.

There should be a specified and therefore identifiable group of neuroanaesthetists who cover the neuroanaesthesia service and these clinicians should have sufficient programmed activities to deliver the elective and emergency service.^2,3

There should be designated consultants in referring hospitals and neuroscience units with overall responsibility for the organisation, infrastructure and processes to enable safe transfer of patients with a brain injury.⁴

An appropriately trained and experienced anaesthetist should be present for all neurosurgical operating lists and interventional neuroradiology sessions, with sufficient consultant-programmed activities to provide adequate supervision and support to anaesthetists in training and staff grade, associate specialist or specialty (SAS) anaesthetists.^3,5

Adequate anaesthetic cover should be available to provide general anaesthesia and sedation for diagnostic neuroradiology (i.e. brain and spine imaging) sessions, including computed tomography (CT) and MRI.

Hospitals should have well-integrated arrangements that ensure anaesthetists covering long neurosurgical procedures or overrunning lists have regular breaks covered by an appropriate colleague for refreshment and comfort breaks.^6,7,8,9 If a case is expected to run over three sessions, consideration should be given to organising a second anaesthetist.

There should be local policy and agreement on how to staff late running lists and lists scheduled to run more than three sessions to prevent fatigue and patient safety issues.

An appropriately skilled and experienced resident anaesthetist should be available at all times to care for postoperative and emergency patients. The experience and skills necessary to provide this cover are not usually found in anaesthetists in training in stage 1.³

Out of hours, consultants should be immediately available (see Glossary) by telephone for advice and be able to attend the hospital within 30 minutes. Suitably skilled and experienced theatre staff should also be available.