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Children and young people undergoing surgery should be placed on designated children’s operating lists in a separate children’s theatre area. When this is not possible, children and young people should be given priority by placing them at the beginning of a mixed list of elective or emergency cases.

A World Health Organization checklist should be completed before and during all procedures and investigations under anaesthesia and sedation, if provided by the anaesthetic department. Appropriate checklists should include issues particularly pertinent to the paediatric age group, such as flushing of IV cannulae prior to discharge to the recovery/post-anaesthesia care unit.⁶³

Business planning by hospitals and anaesthetic departments should ensure that the necessary time and resources are directly targeted towards preoperative preparation.⁵⁸

Hospitals should review their local standards to ensure that they are harmonised with the relevant national safety standards, e.g. National Safety Standards for Invasive Procedures in England⁶⁴ or the Scottish Patient Safety Programme in Scotland.⁶⁵ Organisational leaders are ultimately responsible for implementing local safety standards as necessary.

A child centred approach should be employed whenever possible throughout the care pathway, so that there is physical separation between adult patients and children and young people in the operating department, recovery area, day unit wards and in the emergency department.¹⁵

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...