Search

All cardiac and thoracic units should have regular morbidity and mortality meetings. These should have a list of patients to discuss in advance, an attendance register, and minutes with learning points. Consultant anaesthetists should attend these meetings and where possible inclusion in job plans should be considered. Trainees should be encouraged to attend during their attachments.

Perioperative time should be allocated for the work the anaesthetist undertakes on the day of surgery for both preoperative and postoperative care. The times allocated might vary per patient but for most theatre lists, it approximates to one hour per four hours spent in the operating theatre suite or two hours per eight hours in the operating theatre suite.

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 AA for meal and comfort breaks.^110,111,112

There must be the ability to provide the patient with the appropriate chaperone, as per GMC guidance on intimate examinations and chaperones.¹¹ When examining a patient, anaesthetists must be sensitive to what the patient may consider as intimate, which could include any examination where it is necessary to touch or even be close to the patient.

The anaesthetist should ensure that an adequate supply of oxygen is available before starting any procedure. Many of the sites where anaesthesia is provided outside the main operating theatres do not have piped oxygen; if anaesthesia is provided frequently in such a location, the use of the location should be reviewed or piped oxygen provided. 

In a designated major trauma centre the receiving trauma team should include an anaesthetist,³² and, where possible, this should be an appropriately experienced consultant.³³

Anaesthetists providing sedation for dental procedures should follow the guidance on safe sedation published by the Academy of Medical Royal Colleges and Intercollegiate Advisory Committee on Sedation for Dentistry (IACSD).^35,36,37

Departments might occasionally need to consider allocating two consultants  or other autonomously practicing anaesthetists to work together to provide direct clinical care to patients undergoing major vascular procedures. Examples might include the exploration of infected aortic stent grafts or open thoraco-abdominal aneurysm repair.

Non-specialist tertiary paediatric centres should have a multidisciplinary committee for paediatric care to formulate and review provision. This committee should involve anaesthetists, paediatricians, surgeons, emergency department representatives, senior children’s nurses, managers and other professionals, such as paediatric pharmacists. In some hospitals, this will also include critical care physicians.

Parents and carers should be involved throughout the care process. With the agreement of the anaesthetist in charge of the case on the day, they should be able to accompany children to the anaesthetic room, remain present for induction of anaesthesia and be able to gain easy access to the recovery area. In special circumstances, such as with some small...