Physiotherapy services should be available during the preoperative preparation and postoperative care of patients undergoing thoracic surgery. to discuss anaesthetic risk/consent in pre-assessment clinic rather than on the day of admission/surgery.
Access to measurements of cardiorespiratory function should be available for patients undergoing thoracic surgery, including a facility for cardiopulmonary exercise testing and access to echocardiography.
There should be immediate access to expert radiology advice, x-ray facilities and computerised axial tomography services for patients undergoing thoracic surgery.
All anaesthetic equipment should be checked before use in accordance with the Association of Anaesthetists published guidelines. Anaesthetic machine checks should be recorded in a log and on the anaesthetic chart.16
Where possible, point of care or near patient testing should be used for blood gas analysis, measurement of electrolytes and blood sugar, haemoglobin and coagulation. This might include platelet mapping, thromboelastography or thromboelastometry.17
Immediate access to expert haematology advice, haematology laboratory services and blood products should be available.
Children undergoing thoracic procedures have special requirements and the responsibility for their care should ideally lie with a dedicated paediatric anaesthetist, particularly a cardiothoracic or thoracic paediatric anaesthetist.18 Surgery should only be performed in a specialist tertiary paediatric centre.
Paediatric thoracic surgical patients should be cared for in a unit designed and equipped to care for paediatric patients and staffed by appropriately trained nurses. Such a unit should meet the standards defined for paediatric critical care, including adequate arrangements for retrieval and transfer of patients.19,20
Consultants or autonomously practising anaesthetists providing anaesthesia for lung transplantation should have appropriate training and substantial experience of advanced cardiorespiratory monitoring and support.
