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Local guidance should be developed for the intrahospital transfer of neuroscience patients, based on guidance from Neuro Anaesthesia and Critical Care Society of Great Britain and Ireland (NACCS), Association of Anaesthetists and the Intensive Care Society.⁴⁰

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 AAs for meal and comfort breaks.^3,6

A multidisciplinary team approach is highly recommended, typically involving anaesthetists, obstetricians, surgeons, paediatricians and midwives.^43,44,45

Anaesthetists should be part of the multidisciplinary team engaged in development and implementation of enhanced recovery programmes in cardiac and thoracic surgery.^59,60,64

The RCoA and Association of Anaesthetists currently do not support enhanced roles for AAs until the statutory regulation for AAs is in place. Where such role enhancement exists or is proposed, responsibility should be defined by local governance arrangements.¹¹²

Anaesthetists should have specialised knowledge of the effect of concurrent medications, anaesthetic agents and anaesthetic techniques on the conduct and efficacy of ECT, as well as the specific anaesthetic contraindications.^45,47

Where possible surgery should be postponed until after delivery. If this is not possible, for example in cases of head and neck cancer, a multidisciplinary team approach is highly recommended, typically involving anaesthetists, surgeons, oncologists, obstetricians, midwives and paediatricians and, in cases of thyroid malignancy, endocrinologists.

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.²⁴

Vascular anaesthetists should have the appropriate skills and knowledge regarding invasive cardiovascular monitoring, cardioactive or vasoactive drugs, strategies for perioperative organ protection (renal, myocardial and cerebral), the management of major haemorrhage, and the maintenance of normothermia.⁴¹

In a designated major trauma centre, the receiving trauma team should include an anaesthetist with appropriate airway and damage control resuscitation competencies to manage trauma patients.^48,49