Thoracic anaesthetists working in non-transplant centres should be familiar with the principles of the anaesthetic management of patients who have previously undergone lung transplantation.26
Facilities should be available for the storage, administration and routine monitoring of immunosuppressive medication.
Access to specialist support services such as diabetic medicine and dietetics for patients with cystic fibrosis should be available.
Thoracic anaesthetists should be familiar with the normal physiological effects of pregnancy and the general principles of obstetric anaesthesia.
Where thoracic 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.28
Whenever possible, escalation in care should ideally not lead to the separation of mother and baby.
A subgroup of patients with chronic thromboembolic pulmonary hypertension (CTEPH) will benefit from surgery and should be managed in designated national centres. Currently only one UK centre provides specialist surgical intervention for patients with CTEPH.
The use of extracorporeal membrane oxygenation (ECMO) for the management of adults with severe respiratory failure is centralised in a number of specialist cardiothoracic centres. Anaesthetists often institute ECMO and support retrieval of patients from non-specialist hospitals. Anaesthetists providing ECMO should be suitably trained.29
