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General intraoperative policies outlined in chapter 2 should be held and easily accessible. The following policies for neuroanaesthesia should also be available:

• management and transfer of neuroscience patients⁶
• CPR for patients with their head pinned and for those in the non-supine position
• patients with severe head injury.

Much of neurosurgery involves acute work with a high degree of urgency. The provision of associated services should recognise this need and inappropriate delay should not be allowed to occur as a result of lack of key personnel or facilities. Laboratory services, neuroradiology, availability of operating theatre time and sufficient level 1–3 bed provision should all be organised to cope...

There should be sufficient numbers of clinical programmed activities in consultants’ job plans to provide cover for all elective neurosurgical operating lists and to provide adequate emergency cover.

Departments of neuroanaesthesia and neurocritical care, even if part of a large general department, should be provided with adequate secretarial and administrative support.

Consultants in neuroanaesthesia should be involved in the local and regional planning of any novel neuroscience services e.g. thrombectomy.

Preadmission clinics for elective neurosurgery should be available, with early input from the department of neuroanaesthesia particularly for high risk cases and those where additional time and discussion are required, e.g. awake craniotomy. All centres should be able to demonstrate that discussion of perioperative risk is routine and that specific risks related to, e.g. prone positioning are communicated.^32,33,34

Hospitals should have systems in place to facilitate multidisciplinary meetings for neuroscience services.^35,36

Anaesthesia departments should have a nominated anaesthetist immediately available to provide cover in clinical emergencies, as well as advice and support to other anaesthetists.⁵

A World Health Organization (WHO) checklist adapted for neuroscience procedures should be in use.

The theatre team should all engage in the use of the WHO surgical safety process, commencing with a team brief, and concluding the list with a team debrief.³⁴ Debrief should highlight things done well and also identify areas requiring improvement. Teams should consider including the declaration of emergency call procedures specific to the location as part of the team brief.