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An appropriately trained and experienced anaesthetist with regular commitments to burn and plastic surgery should be present during the conduct of general and regional anaesthesia for operative procedures, including those procedures requiring intravenous sedation where it has been agreed that this will be provided by the anaesthetic department.

Anaesthetists should always be supported by dedicated, appropriately skilled and trained assistants, and the recovery facilities should be staffed during all operating hours and have appropriate anaesthetic support until the patient meets agreed discharge criteria.⁹

In order to maintain the necessary repertoire of skills, anaesthetists providing a burn and plastic surgery anaesthetic service should have a regular commitment to the specialty, and adequate time must be made for them to participate in a range of relevant continuing medical education (CPD) activities.

At centres where 24/7 primary percutaneous coronary interventions are performed, and in designated heart attack centres, which 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.

Anticipated difficulty with anaesthesia should be brought to the attention of the anaesthetist as early as possible before surgery. This includes planned admission to a critical care unit, the need for special skills, such as those of fibre optic intubation, obesity, complex pain problems or a known history of anaesthetic complications.

Local guidance should be developed for the intrahospital transfer of neuroscience patients, based on guidance from Neuro Anaesthesia and Critical Care Society of Great Britain and Ireland (NACCS), Association of Anaesthetists and the Intensive Care Society.⁴⁰

Anaesthesia departments should make arrangements to allow anaesthetists working solo during long surgical procedures or on overrunning lists to be relieved by a colleague or AAs for meal and comfort breaks.^3,6

A multidisciplinary team approach is highly recommended, typically involving anaesthetists, obstetricians, surgeons, paediatricians and midwives.^43,44,45

Anaesthetists should be part of the multidisciplinary team engaged in development and implementation of enhanced recovery programmes in cardiac and thoracic surgery.^59,60,64

The RCoA and Association of Anaesthetists currently do not support enhanced roles for AAs until the statutory regulation for AAs is in place. Where such role enhancement exists or is proposed, responsibility should be defined by local governance arrangements.¹¹²