All cardiothoracic units should provide patient information about preoperative smoking cessation, including how to access local services to support patients wishing to quit before their operation.
In recent years there has been a trend towards assessment of elective patients in preadmission clinics, typically one to two weeks before surgery. This allows routine paperwork and investigations to be completed before admission, permits ‘same day’ admission and reduces the likelihood of delays or cancellation.48,49,50,51 Anaesthetists should be part of the preadmission...
Cardiac anaesthesia services are provided for patients undergoing cardiac procedures. To reflect current practice, these guidelines have been more clearly divided to identify areas of differing requirement. Anaesthetists in cardiac surgical services are now more frequently required to provide anaesthesia for invasive cardiology procedures in the catheter laboratory. Intraoperative transoesophageal echocardiography is a specialist skill that cardiac anaesthetists are...
Availability of two consultant anaesthetists, or a consultant and senior trainee or SAS doctor should be considered for more complex procedures, such as lung resection requiring ECMO1
Continuity of care should be a priority in prolonged procedures and, when this is not possible, a formal documented process with some overlap should be in place for handover of clinical care from one anaesthetist to another.2
The complexity of some procedures neccessitates anaesthetic involvement in multidisciplinary team meetings and this activity should be reflected in job plans.
Consultant or autonomously practising anaesthetists in thoracic units should be responsible for the provision of service, teaching, protocol development, management, research and quality improvement. Adequate time should be allocated in job plans for these activities.
Each unit should have a designated clinical lead (see glossary) anaesthetist for thoracic anaesthetic services. This should be recognised in their job plan and they should be involved in multidisciplinary service planning and governance within the unit.
An appropriately trained consultant or autonomously practising anaesthetist should be available at all times, through a formal thoracic or cardiothoracic anaesthetic on-call rota, particularly if lung transplantation is performed.
Wherever thoracic anaesthesia and surgery are performed there should be a resident anaesthetist available at all times.
