The definitive care of complex spinal and pelvic injuries requires early multidisciplinary specialist spinal (orthopaedic or neurosurgical surgery) and pelvic team discussion. The anaesthetist managing such cases should have appropriate training and experience in management of these complex patients including management of associated complications.
All institutions where sedation is practised should have a sedation committee. This committee should include key clinical teams using procedural sedation and there should be a nominated clinical lead for sedation. In most institutions, the sedation committee should include an anaesthetist, at least in an advisory capacity.
Many procedures do not have to be performed out of hours.35Anaesthetists and surgeons together should devise departmental protocols for the handling of patients requiring urgent procedures, to allow prioritisation from both surgical and anaesthetic perspectives.
Any autonomously practising anaesthetist working in neuroanaesthesia must undertake continuing professional development (CPD) in neuroanaesthesia and must have sufficient regular programmed activities within this field to ensure that their specific skills and experience are maintained.27
There should be a minimum of one member of the recovery staff, or an anaesthetist with advanced training in paediatric life support on duty. All members of recovery staff should have up-to-date paediatric competencies including resuscitation.199
Cardiothoracic anaesthetists should be familiar with the normal physiological effects of pregnancy and the general principles of obstetric anaesthesia.
The duty anaesthetist should have a clear line of communication to the supervising consultant at all times.
The anaesthetist should consider all environmental factors when planning administration of anaesthesia or sedation.
Anaesthetists with an appropriate level of training should manage patients undergoing major elective vascular surgery.
