The provision of formal and systematic training should be considered. Head and neck surgery provides an excellent opportunity for training anaesthetists in the use of advanced methods for airway management and the shared airway, including videolaryngoscopy, flexible bronchoscopic, and jet and apnoeic oxygenation techniques.
In all hospitals undertaking major vascular anaesthesia a vascular anaesthetist should be appointed clinical lead (see Glossary) to manage service delivery. This should be recognised in their job plan, and they should be involved in multidisciplinary service planning and governance within the unit.
At centres where 24/7 primary percutaneous coronary interventions are performed, and in designated heart attack centres that include out of hospital cardiac arrest patients, there should be provision for immediate availability of a resident anaesthetist, skilled assistance and appropriate equipment and facilities.
Anaesthetists should be aware of the risks of exposure to ionising radiation in cardiac catheterisation laboratories and should ensure that they use protective garments and screens and wear exposure monitoring devices if requested to do so.46
Continuity of care should be a priority in prolonged procedures and, when this is not possible, a formal documented process with some overlap should be in place for handover of clinical care from one anaesthetist to another.2
Anaesthetists who provide emergency care outside burn services should be trained in the initial management of the patient with severe burns, including timely emergency assessment, resuscitation and transfer to a burns service.61
All patients requiring anaesthesia, pain management or perioperative medical or critical care should have a named and documented supervisory autonomously practising anaesthetist (see Glossary) who has overall responsibility for the care of the patient.
