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Specialist positioning equipment for the induction of anaesthesia and intubation in the morbidly obese patient should be available.^85,127

Bariatric patients requiring emergency surgery should have experienced surgeons and anaesthetists available (typically, but not exclusively, at a consultant level), in order to minimise operative time.^85,127

Bariatric patients should be considered for level 2 or 3 critical care postoperatively.^85,127

There is evidence that introduction of evidence based care bundles for the management of emergency laparotomies can improve outcomes.²⁸ Hospitals should have care bundles for the anaesthetic management of common and high risk surgical emergency patients.¹

Complications have been shown to have a major impact on both short term and long term outcome, and so hospitals should have clinical and managerial strategies to reduce these to a minimum.^4,15,113

To facilitate optimal care of high risk patients, systems should be in place to ensure:^1,3,33

• timely surgical review (typically at a consultant level), and access to diagnostic imaging and urgent reporting
• documented evaluation of mortality and relevant morbidity risk prior to surgery^131,132
• communication of risk to the multidisciplinary clinical team, to...

Hospitals should contribute to national audits; benchmark themselves against national recommendations resulting from these audits and change practice in response to rapidly developing national guidance. Hospitals should develop local quality improvement programmes that are responsive to local requirements. Where data are not available from national data collections, data collection should be responsive to local issues. Clinicians performing this work should...

Hospitals should provide the services and resources required for the management of the emergency surgical patient with diabetes including explicit managerial and clinical policies.¹³⁴

Hospitals should consider appointing a lead anaesthetist for diabetes.

Preoperative fasting should be minimised as much as possible, especially for infants and younger children.^23,24