Search

There should be onsite laboratory provision, or near patient testing, for blood gases, serum electrolytes, platelet function assay, activated clotting time and thromboelastography, to allow safe management of patients in the operating theatre.²⁴

Rapid access to other biochemical and haematological investigations and blood transfusion should be provided.²⁵

Transfer times between the procedure room and critical care should be minimised. In new buildings, this may be achieved by having theatres, the critical care unit and radiological facilities within close proximity and preferably on the same floor. An integrated approach should be taken when planning new facilities.²⁶

Adequate provision should be made for monitoring patients during such transfer. Current evidence is supportive of the use of processed EEG (pEEG) monitoring where neuromuscular blocking agents are in use, although the limitations of current technology may hamper this.^23,27

Postoperative recovery facilities, with appropriately trained staff and equipment, should be available to all neurosurgical and neuroradiological patients undergoing surgery, both elective and emergency.²⁸

Whether in a dedicated paediatric neurosurgical unit or not, every child requiring elective neurosurgery should have care delivered by an anaesthetist or anaesthetists who possess the relevant competencies as demanded by the patient’s age, disease and comorbidities.

New appointees to consultant posts with a significant or whole time interest in paediatric neuroanaesthesia should have successfully completed Advanced Level training in paediatric anaesthesia as defined in the certificate of completion of training (CCT) in anaesthesia.²⁹

Paediatric and neuroscience centres should consider partnering to help each maintain expertise of the other area.

In a true emergency situation involving a child requiring urgent neurosurgery for a deteriorating condition admitted to an ‘adult only’ neurosurgical service, the most appropriate surgeon, anaesthetist and intensivist available would be expected to provide life saving care, including emergency resuscitation and surgery.³⁰

Equipment and accessories appropriate for the age and size of any patient should be available and maintained in accordance with manufacturers' recommendations.