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Whether in a dedicated paediatric neurosurgical unit or not, every child requiring elective neurosurgery should have care delivered by an anaesthetist or anaesthetists who possess the relevant competencies as demanded by the patient’s age, disease and comorbidities.
New appointees to consultant posts with a significant or whole time interest in paediatric neuroanaesthesia should have successfully completed Advanced Level training in paediatric anaesthesia as defined in the certificate of completion of training (CCT) in anaesthesia.29
Paediatric and neuroscience centres should consider partnering to help each maintain expertise of the other area.
In a true emergency situation involving a child requiring urgent neurosurgery for a deteriorating condition admitted to an ‘adult only’ neurosurgical service, the most appropriate surgeon, anaesthetist and intensivist available would be expected to provide life saving care, including emergency resuscitation and surgery.30
Equipment and accessories appropriate for the age and size of any patient should be available and maintained in accordance with manufacturers' recommendations.
The anaesthetist should be with the patient at all times while the patient is under anaesthesia. In hospitals employing AAs, this responsibility may be delegated to a AAs, supervised by a consultant anaesthetist in accordance with the scope of practice for AAs.3,4
Appropriate neurocritical care facilities should be available for all children.
Consultants and SAS doctors working in neuroanaesthesia should have sufficient regular programmed activities within this field to ensure that their specific skills and experience are maintained.
Departments should consider providing newly appointed consultants with a mentor to facilitate their development in neuroanaesthesia if they have had limited experience in the specialty as a trainee.
Consultant anaesthetists who provide out of hours cover to the neuroscience unit, but do not provide neuroanaesthesia in working hours, should be able to demonstrate the maintenance of appropriate skills and knowledge through regular clinical involvement and continuing professional development (CPD).
