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All children and young people should be assessed before their operation by an anaesthetist. Parents and carers, as well as the child, should be given the opportunity to ask questions and to be involved in the physical and psychological preparation for surgery.

Parents and carers should be involved throughout the care process. With the agreement of the anaesthetist in charge of the case on the day, they should be able to accompany children to the anaesthetic room, remain present for induction of anaesthesia and be able to gain easy access to the recovery area. In special circumstances, such as with some small...

Anaesthetic assistants should be appropriately skilled and have up to date experience in neuroanaesthesia.

All post anaesthetic recovery staff looking after neuroscience patients should be able to recognise and describe complications following neuroanaesthesia and possess skills to obtain multidisciplinary assistance and escalate treatment according to departmental protocols and guidance.

Where departments use post anaesthetic recovery units for extended recovery, the post anaesthetic recovery staff caring for those patients should have the competencies to manage Level 2 critical care patients and there should be a registered nurse/patient ratio of 1:2, as in a Level 2 critical care unit.¹⁵ Departments should have procedures in place to demonstrate the adequacy...

Specific equipment for difficult airway management should be available.

Units should have access to ultra short acting opioids with stable context sensitive half times deliverable by infusion a software accommodating a range of appropriate pharmacokinetic (PK) models to permit intraoperative cardiostability, smooth emergence from anaesthesia and rapid and accurate postoperative neurological assessment.

Equipment to comply with Association of Anaesthetists standards for anaesthetic monitoring should be available.¹⁶

Clinical governance of AAs should follow the same principles as applied to medically qualified staff. This should include training that is appropriately focused and resourced, supervision and support in keeping with practitioners’ needs and practice responsibilities, and practice centred audit and review processes.

Depth of anaesthesia monitoring, including processed electroencephalography (EEG) monitors, should be available intraoperatively and for transfer.^17,18