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There should be a dedicated trained assistant (i.e. an ODP, anaesthetic nurse or equivalent) who holds a valid registration with the appropriate regulatory body, immediately available in every location in which anaesthesia care is being delivered, whether this is by an anaesthetist or an AA.^41,119

Complex ophthalmic surgical cases often require specialised anaesthetic input. This may include patients having repeated ophthalmic procedures, long and difficult cases, and those potentially requiring specialist intravenous drug therapy, such as intravenous steroids, acetazolamide or mannitol. An anaesthetist of appropriate experience should have dedicated responsibility for operating lists containing such complex cases.

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. This should take place at the earliest possible opportunity to maximise the time available for optimisation and shared decision making.⁵

All regional anaesthesia equipment (nerve stimulators, ultrasound machine and infusion pumps) should have user manuals and should be checked prior to use in accordance with the Association of Anaesthetists’ published guidelines alongside regular maintenance and replacement programmes.^33. A planned maintenance and replacement programme should be in place.

Patients with morbid obesity who require emergency surgery should have experienced anaesthetists and surgeons available (typically, but not exclusively, at consultant level) to minimise operative time.¹⁷³ A surgical team familiar with emergency surgery in patients with morbid obesity and the complications associated with laparoscopic surgery should be available.

All patients over the age of 65 undergoing emergency laparotomy should have a formal assessment of frailty. Surgeons, anaesthetists and intensivists should ensure frailty has been taken into account when assessing the mortality risk as the NELA risk score does not take frailty into account.¹²⁹ 

Hospitals should have well integrated arrangements that ensure anaesthetists covering long neurosurgical procedures or overrunning lists are regularly relieved by an appropriate colleague for refreshment and comfort breaks.

Experienced anaesthetic and surgical staff should manage obese patients. Ideally, morbidly obese patients should be preassessed by a senior anaesthetist.³⁵