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Specific equipment for difficult airway management should be available.

Units should have access to ultra short acting opioids with stable context sensitive half times deliverable by infusion a software accommodating a range of appropriate pharmacokinetic (PK) models to permit intraoperative cardiostability, smooth emergence from anaesthesia and rapid and accurate postoperative neurological assessment.

Equipment to comply with Association of Anaesthetists standards for anaesthetic monitoring should be available.¹⁶

Clinical governance of AAs should follow the same principles as applied to medically qualified staff. This should include training that is appropriately focused and resourced, supervision and support in keeping with practitioners’ needs and practice responsibilities, and practice centred audit and review processes.

Depth of anaesthesia monitoring, including processed electroencephalography (EEG) monitors, should be available intraoperatively and for transfer.^17,18

Monitoring equipment to detect air embolism and catheters for air aspiration should be available. The use of multiorifice catheters should also be considered.¹⁹

Those units conducting functional neurosurgery or surgery for correction of scoliosis, other relevant spinal surgery, or surgery for some cranial lesions, e.g. cerebellopontine angle tumours, should have the appropriate equipment and adequate numbers of trained staff for intraoperative neurophysiological testing. Neuroanaesthetists should be aware of the implications of this testing for anaesthesia including blood pressure management, use of neuromuscular blockade...

Equipment for safe positioning of patients with a wide range of body habitus should include:  

• appropriate sized mattresses
• positioning aids to minimise risk of eye injury, nerve injury as well as skin damage, e.g. pressure sores, during potentially prolonged operations
• fixings to prevent accidental movement during the procedure.

Equipment to monitor patient temperature and to provide targeted temperature management should be available.²¹

Availability of a cell salvage system should be considered for procedures associated with a risk of blood loss exceeding 25% of circulating volume.^22,23 Staff who operate this equipment should receive training in how to operate it and frequently use it to maintain their skills.