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When a child undergoes anaesthesia or an anaesthetic department provides sedation services, there should be a dedicated trained assistant, i.e. an operating department practitioner (ODP) or equivalent, who has had paediatric experience and maintained their paediatric competencies.¹⁰

In the period immediately after anaesthesia, the child should be managed in a recovery area, staffed on a one-to-one basis at least until the child can manage their own airway. The staff in this area should have paediatric experience and current paediatric competencies, including resuscitation.^10,11

A member of staff with advanced training in life support for children should always be available to assist where required.^12,13,14

In situ simulation training can help to identify system process gaps.⁹² Simulation-based learning techniques should be used to assist anaesthetists to resolve these issues and develop the necessary technical and non-technical skills.^{93,94,95,96,97,98,99,100,101,102,103}

There should be induction programmes for all new members of staff, including locums. Induction for a locum doctor should include familiarisation with the layout of the labour ward, the location of emergency equipment and drugs (e.g. MOH trolley/intralipid/dantrolene), access to guidelines and protocols, information on how to summon support/assistance, and assurance that the locum is capable of using the equipment...

Anaesthetists with a job plan that includes obstetric anaesthesia must demonstrate ongoing continuing education in obstetric anaesthesia, and continuing professional development as needed for this aspect of their work.¹⁰⁴ Hospitals have a responsibility to enable this with local teaching where appropriate, and by facilitating access to other education and training.^96,105,106

Any non-trainee anaesthetist who undertakes anaesthetic duties in the labour ward should have been assessed as competent to perform these duties in accordance with OAA and RCoA guidelines.^31,55,89 Such a doctor should work regularly in the labour ward but should also regularly undertake non-obstetric anaesthetic work to ensure maintenance of a broad range of anaesthetic skills.

All staff working on the delivery suite should have annual resuscitation training, including the specific challenges of pregnant women.¹⁰⁷

Preoperative care requires careful co-ordination and communication with individual surgeons, general practitioners, medical records, outpatient clinics and specialist services such as diabetes. The anaesthetic lead for the preoperative preparation clinic should ensure adequate systems are in place, and be responsible for overseeing the adequacy of these processes.⁶

Anaesthetists should contribute to the education and updating of midwives, anaesthetic assistants and obstetricians.