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If the consultant on call is not a neuroanaesthetist, there should be a clearly defined and understood process for the provision of specialist advice from neuroanaesthesia colleagues. Where possible, local arrangements should be considered to facilitate this telephone advice in non-neuroscience centres when required.

Departments that participate in national initiatives (e.g. services for thrombectomy) should review their staffing arrangements to ensure timely emergency cover.^10,11 Thrombectomy should have a protocol-led service, ideally staffed by neuroanaesthetists.¹²

Anaesthetic assistants should be appropriately skilled and should have up-to-date experience in neuroanaesthesia.

All post-anaesthetic recovery staff looking after neuroscience patients should be able to recognise and describe complications following neuroanaesthesia and should possess skills to obtain multidisciplinary assistance and escalate treatment according to departmental protocols and guidance.

Where departments use post-anaesthetic recovery units for extended recovery, the post-anaesthetic recovery staff caring for those patients should have a registered nurse or operating department practitioner: patient ratio of 1:2, as in a level 2 critical care unit. However, the care of an individual patient should be delivered on a one to one basis until the patient is able to maintain...

Mechanical thrombectomy for acute ischaemic stroke should be available in specialist stroke centres; most are based within neurosurgical units. This will involve a formal network with an acute stroke centre served by regional comprehensive stroke centres.

Anaesthetic support for mechanical thrombectomy should involve anaesthetic staff with appropriate training and experience in neuro-anaesthetic care and remote site anaesthesia. Operating department practitioner/anaesthetic nurse support should be available.³⁰

Protocols should be developed to ensure that accurate clinical information is available in a timely manner to the anaesthetist to avoid any delays in treatment. There should be an agreed process for alerting the mechanical thrombectomy team if anaesthetic provision is unavailable to allow referral to another mechanical thrombectomy centre.

The decision whether to perform mechanical thrombectomy under local or general anaesthesia is based on the individual patient; with close communication with the neurointerventionalist. All patients should receive monitoring with the provision to convert to a general anaesthetic if needed.¹³

Agreed local guidelines should include who should be managed under general anaesthesia.