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Anaesthesia associates should work under the supervision of a consultant or autonomously practising anaesthetist at all times, as required by the RCoA.³²

Appropriate and comprehensive training for anaesthetists in this subspecialty should be given according to current standards as defined by the RCoA.⁶³

Agreed local clinical guidelines should be in use, produced by an appropriately constituted multiprofessional team comprising anaesthetists, specialist nurses, surgeons, critical care clinicians, pharmacists, specialty consultants or autonomously practising anaesthetists and managers. These guidelines should cover at least the following:

• airway management, including follow-up for difficult situations (both plastic surgery and burn reconstructive surgery)⁷⁶
• monitoring of free flaps^47...

Hospitals should have well integrated arrangements that ensure anaesthetists covering long neurosurgical procedures or overrunning lists are regularly relieved by an appropriate colleague for refreshment and comfort breaks.

Experienced anaesthetic and surgical staff should manage obese patients. Ideally, morbidly obese patients should be preassessed by a senior anaesthetist.³⁵

Only individuals who appear on the voluntary register currently administered by the Royal College of Anaesthetists should be employed in the AAs role.¹⁴

The supervising consultant anaesthetist should not be responsible for more than two anaesthetised patients simultaneously, where one involves supervision of a AAs.³

Consultant anaesthetists and intensivists should be involved in the planning of local trauma services. Those with defined responsibility for major trauma management should be engaged in the layout and logistics of the resuscitation room.

Trained staff and appropriate facilities should be immediately available for emergency resternotomy and bypass. A suitably trained resident anaesthetist should be immediately available for emergencies.⁵

An appropriately trained consultant anaesthetist should be available at all times, through a formal thoracic or cardiothoracic anaesthetic on-call rota, particularly if lung transplantation is performed.