Anaesthetic care should be consultant or autonomously practising anaesthetist led, when possible. A neurocritical care facility should be available if needed after the procedure or a monitored bed on a hyperacute stroke unit as appropriate.
All units should audit their practice regularly to look at types of anaesthesia, timing, agents used and complications and review of service delivery.
All staff working in MRI units must be trained in MR safety. The use of checklists before transfer to the scanner should be routine.29
Neurocritical care should commence/continue in theatre; therefore standard operating protocols for invasive lines, monitoring and tracheal tubes should reflect local critical care policy.
Departments of emergency medicine may also wish to adopt these standard operating procedures.
Whether in a dedicated paediatric neurosurgical unit or not, every child requiring elective neurosurgery should have care delivered by an anaesthetist or anaesthetists who possess the relevant competencies as demanded by the patient’s age, disease and comorbidities.
New appointees to consultant posts with a significant or whole-time interest in paediatric neuroanaesthesia should have successfully completed stage 3 training in paediatric anaesthesia as defined in the certificate of completion of training (CCT) in anaesthesia.27
Paediatric and neuroscience centres should consider partnering to help each to maintain expertise of the other area.
In a true emergency situation involving a child requiring urgent neurosurgery for a deteriorating condition admitted to an ‘adult only’ neurosurgical service, the most appropriate surgeon, anaesthetist and intensivist available would be expected to provide lifesaving care, including emergency resuscitation and surgery.28
Equipment and accessories appropriate for the age and size of any patient should be available and maintained in accordance with manufacturers' recommendations.
