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If complaints are made about anaesthetic aspects of care, a consultant or other autonomously practising anaesthetist should review and assess the patient’s complaint, discussing her concerns and examining her where appropriate. This should be clearly documented alongside any subsequent action taken. Referral for further investigations may be required.

Patients requiring head and neck procedures should be attended by anaesthetists who have had an appropriate level of training in this field and who have acquired the relevant knowledge and skills needed to care for these patients.^41,42 

The standard of monitoring in the operating theatre should allow the conduct of safe anaesthesia for surgery as detailed by the Association of Anaesthetists standards of monitoring.⁴ Quantitative neuromuscular monitoring is beneficial during Robotic assisted thoracic surgery (RATS) to avoid inadvertent patient movement and injury.

All thoracic units should have regular morbidity and mortality meetings. These meetings should be provided with a list of patients to discuss in advance, an attendance register, and minutes with learning points. Consultants or autonomously practising anaesthetists should attend these meetings and they should be included in job plans. Trainees should be encouraged to attend during their attachments.

There is a high incidence of ‘awareness’ under sedation and subsequent post-traumatic stress. The anaesthetist should obtain informed consent from the patent before any sedation is administered. This includes using descriptions of levels of sedation from the patient’s perspective.⁸⁸

Where a patient is seen prior to the day of surgery and shared decision making and discussion of anaesthetic conduct has taken place, the anaesthetist on the day of surgery has a responsibility to ensure the patient still understands and agrees with the perioperative plan.^66,67

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.^116,117,112

AAs should always work within an anaesthesia team led by a consultant or other autonomously practising anaesthetist who has overall responsibility for the anaesthesia care provided for the patient and whose name should be recorded in the individual patient’s medical notes.¹¹⁸

Decision support systems for crisis scenarios should be available, for example the Association of Anaesthetists Quick Reference Handbook, advanced life support algorithm, difficult airway guidelines and major haemorrhage protocols.^142,143,144

Monitoring equipment should be used in accordance with the Association of Anaesthetists minimum standards of monitoring.^{121,129,183,193}