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Specialist anaesthetists should be involved in the discussion of referrals and planning when conducted in the setting of a multidisciplinary team. This involvement should be recognised in job plans. Anaesthesia for complex adult congenital heart procedures should be undertaken by suitably trained adult congenital anaesthetists. Appropriate support from ACHD cardiologists and other cardiologists with suitable expertise in ACHD is necessary.33
Consultants or autonomously practising anaesthetists providing anaesthesia for heart or lung transplantation should have appropriate training and substantial experience of advanced cardiovascular monitoring and support.
Cardiac anaesthetists working in non-transplant centres should be familiar with the principles of the anaesthetic management for patients who have previously undergone heart or lung transplantation.42
Patients undergoing heart or lung transplantation may be under the age of 18 years. Anaesthetists must be aware of legislation and good practice guidance relevant to young and vulnerable adults.35,41 Children undergoing transplantation should be cared for in a paediatric centre.
Facilities should be available for the storage, administration and routine monitoring of immunosuppressive medication.
Cardiac anaesthetists should be familiar with the normal physiological effects of pregnancy and the general principles of obstetric anaesthesia.43
Where cardiac surgery is scheduled to occur immediately after caesarean section, there should be early involvement of obstetricians, specialist obstetric anaesthetists, neonatal paediatricians and midwifery services.
Equipment, services and facilities should be equivalent to those found in an obstetric unit.44
Whenever possible, escalation in care should ideally not lead to the separation of mother and baby.
A multidisciplinary team should agree and document plans in advance for the peripartum management for patients with known congenital or acquired cardiac disease. Staff and facilities should be available for monitored or operative delivery and for managing acute decompensation.
