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Ultrasound should be available for the placement of vascular catheters and should be available for regional anaesthesia techniques.

During the transfer of the patient at the end of surgery to the postoperative care unit there should be access to electrocardiogram (ECG), blood pressure monitoring, pulse oximetry, disconnection alarm for any mechanical ventilation system, fractional inspired oxygen concentration, and end-tidal carbon dioxide.⁴ The vast majority of thoracic patients are extubated on the operating table. Some do not have/require...

Designated thoracic, or cardiothoracic wards should be considered.

Thoracic surgery should ideally be performed in dedicated operating rooms. It is unlikely that an operating room will be kept available at all times for emergencies. Local arrangements for urgent and emergency situations should be in place.

RATS should be delivered in a theatre with adequate capacity to allow comfortable movement of staff around the patient and robot, to safely accommodate all of the additional equipment including robot, operating console and monitoring stack, and to allow sufficient space for rapid removal of the robot in an emergency to facilitate resuscitation.

After major thoracic surgery, patients should be transferred to an appropriately sized, equipped and staffed post-anaesthetic recovery area. Planned or emergency access to intensive or high-dependency care should be available.¹¹

Non-invasive ventilation facilities should be available in the immediate postoperative period, for example bilevel positive airway pressure (BiPAP), CPAP and high-flow nasal oxygen therapy (HFNO). HFNO should be available in theatres for induction and support of anaesthesia as required^.12

Thoracic surgery units should develop an enhanced recovery after surgery programme.^13,14

Preoperative assessment clinics should be established to optimise patient preparation for surgery and reduce same day cancellations. Smoking cessation support should be available to all thoracic patients.

Thoracic surgery should be supported by a specialist pain service. Pain relief protocols should be clearly defined for thoracic surgery patients.¹⁵