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Anaesthetists should have specialised knowledge of the effect of concurrent medications, anaesthetic agents and anaesthetic techniques on the conduct and efficacy of ECT, as well as the specific anaesthetic contraindications.^45,47

Where possible surgery should be postponed until after delivery. If this is not possible, for example in cases of head and neck cancer, a multidisciplinary team approach is highly recommended, typically involving anaesthetists, surgeons, oncologists, obstetricians, midwives and paediatricians and, in cases of thyroid malignancy, endocrinologists.

Patients awaiting complex head and neck surgery (for benign or malignant pathology), or with significant comorbidities, should be seen in the preassessment clinic by an experienced anaesthetist who ideally will be involved in their perioperative pathway.²⁴

Vascular anaesthetists should have the appropriate skills and knowledge regarding invasive cardiovascular monitoring, cardioactive or vasoactive drugs, strategies for perioperative organ protection (renal, myocardial and cerebral), the management of major haemorrhage, and the maintenance of normothermia.⁴¹

In a designated major trauma centre, the receiving trauma team should include an anaesthetist with appropriate airway and damage control resuscitation competencies to manage trauma patients.^48,49

Trauma and orthopaedic surgery should be included in anaesthetic departmental audit programmes, including continuing audit of complications and adverse events. The trauma anaesthetists should have provision in their job plan to attend trauma MDT meetings for discussion regarding high risk patients.

Anaesthetists who care for children should have received appropriate training and must ensure that at annual appraisals competence in anaesthesia and resuscitation is deemed adequate for the cases undertaken by that individual.^3,4

A dedicated, appropriately trained anaesthetic assistant, who is familiar with that specific environment, should be available in all non-theatre environments where anaesthesia or deep sedation is undertaken by an anaesthetist.^8,9

Anaesthesia for non-theatre environment should be delivered by a competent individual with appropriate supervision; the level of supervision should reflect the severity of the case and the seniority of the individual in accordance with the RCoA's Guidance on Supervision Arrangements for Anaesthetists.¹⁷

Appropriate exposure should be given to anaesthetists during their training to develop skills in reasonable adjustments and anxiolysis. Allied professionals specialising in this area should also be given training.^44,45