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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

ECMO support may be used to provide procedural support for selected thoracic surgical procedures such as central airway surgery or severe broncho-pulmonary fistulae – such provision requires specialist care and should be centralised to appropriate centres.

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.³⁰ Anaesthetists should be part of the preadmission clinical pathway, including implementing interventions...

Patients listed for thoracic surgery should have timely access to pre-operative investigations such as lung function and echocardiography, particularly for tumour resection surgery.

Thoracic anaesthesia is a ‘key unit of training’ in both the 2010 intermediate level training in anaesthesia³⁴ and in the newer 2021 Curriculum Stage 2.³⁵of training. Trainee anaesthetists should be of appropriate seniority to be able to benefit from this area of training. Stage 3 training of the 2021 Curriculum also requires trainees to be proficient...

All trainees should be appropriately clinically supervised at all times.³⁷

Trainees should have an appropriate balance between thoracic anaesthesia and ICU training based on their individual requirements.³⁸