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Anaesthesia may be required for radiotherapy, to facilitate patient positioning and to alleviate pain. Owing to the unique nature of the procedures involved in radiotherapy, the remoteness of the location and the lack of direct access to the patient, only appropriately experienced anaesthetists familiar with the therapy should embark on anaesthesia for these patients.⁷³

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 lifesaving care, including emergency resuscitation and surgery.²⁸

Local guidance should be developed for the intrahospital transfer of neuroscience patients, based on guidance from the Neuroanaesthesia and Neurocritical Care Society (NACCS), the Association of Anaesthetists and the Intensive Care Society.^41,42,43

Adequate emergency theatre time should be provided throughout the day to minimise delays and avoid emergency surgery being unnecessarily undertaken out of hours when the hospital may have reduced staffing to care for complex postoperative patients. Consideration should be given to staffing of additional evening (twilight) emergency sessions with autonomously practising anaesthetists.

An anaesthetist, anaesthesia associate or advanced nurse practitioner should preoperatively assess all patients undergoing emergency surgery who require anaesthesia. Adequate time should be available for this assessment to occur as clinical urgency allows.^43,47

Anaesthetists with a job plan that includes emergency anaesthesia should demonstrate continuing education in emergency anaesthesia and continuing professional development as required for this aspect of their work. Departments have a responsibility to enable this development with local teaching where appropriate and by facilitating access to other education and training.19

Children with severe comorbidities who require emergency anaesthesia should be treated in a specialist paediatric centre. However, if transfer is not feasible, the most appropriately experienced senior anaesthetist should provide anaesthesia and support resuscitation and stabilisation.^170,171

There should be a duty anaesthetist immediately available for the obstetric unit 24/7. As their primary responsibility is to provide care to those in labour or who require medical or surgical interventions, ante or peripartum, the role should not include undertaking elective work during the duty period.²²

There should be a system in place for antenatal anaesthetic review by a senior anaesthetist for women who are morbidly obese.¹⁰³ Assessment should be arranged to ensure that timely delivery planning can take place.¹⁰⁴

An anaesthetist should be included in the MDT antenatal management planning for those with complex medical needs.³ Planning should be in the form of shared decision making and include consideration of the woman’s wishes and preferences.^136,137