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Patients with obstructive sleep apnoea have a higher incidence of postoperative complications including hypoxia, renal failure, unplanned intensive care unit (ICU) stay, and delayed discharge. Therefore, consideration should be given to monitoring such patients in an high dependency unit (HDU) environment postoperatively.⁴⁴

Patient care should be transferred to staff who have been specially trained in recovery procedures and reached locally or nationally agreed prescribed competencies,³ such as the UK National Core Competencies for Post-Anaesthesia Care 2013.⁴

On many occasions, patients will be handed over to the recovery practitioner with a laryngeal mask airway or other supraglottic airway device in place. The person taking over direct clinical care should be specifically trained in the management of these patients and in the safe removal of the airway device.⁵

If a patient is transferred to the post-anaesthesia care unit (PACU) with a tracheal tube in place, the anaesthetist remains responsible for the removal of the tube but may delegate its removal. Delegation should be to an appropriately trained member of the PACU staff who is prepared to accept this delegated responsibility.⁴

An anaesthetist should have overall responsibility for the transport of patients from theatre to the PACU.⁶

Anaesthetists should formally handover the patient, stay if their input is needed and leave the patient in a stable condition.^5,7,8

The patients’ anaesthetist should retain overall responsibility for the patient during the recovery period and should be readily available for consultation until the patient is able to maintain their own airway, has regained respiratory and cardiovascular stability and is able to communicate, unless this care has been handed over to another named anaesthetist

Until the patient is able to maintain their own airway, has regained respiratory and cardiovascular stability and is able to communicate, continuous individual observation and care of each patient should be performed on a one to one basis. All PACUs should be staffed to a level that allows this to be routine practice (this could be assessed using queuing theory...

A minimum of two members of staff should be present (of whom at least one should be a registered practitioner) when there is a patient in the PACU who does not fulfil the criteria for discharge to the ward. If this level of staffing cannot be assured, an anaesthetist should stay with the patient until satisfied that the patient fulfils...

There should be an anaesthetist or a professional with suitably qualified airway skills who is available for patients in the PACU within three minutes.^10,11