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Anaesthesia for ECT is frequently performed in remote locations. Ideally, a consultant or an autonomously practising anaesthetist (see Glossary) should provide general anaesthesia. Appropriately trained recovery and operating department staff should be provided, and the guidance provided for anaesthetic provision in remote sites should be followed.⁶⁹

Patients undergoing lung transplantation may be under the age of 18 years. Anaesthetists must be aware of legislation and good practice guidance relevant to young and vulnerable adults.,^21,27Children undergoing transplantation should be cared for in a paediatric centre.

A minimum of two members of staff should be present (of whom at least one should be a registered practitioner) when there is a patient in the recovery unit who does not fulfil the criteria for discharge to the ward. If this level of staffing cannot be assured, an anaesthetist should stay with the patient until satisfied that the patient...

Patients exhibit extremely wide variation in response to drugs used for sedation. It is difficult to and undesirable to have to manipulate the airway of an unpredictably over-sedated patient during surgery, and so administration of intravenous sedation during ophthalmic surgery should only be undertaken by an anaesthetist whose sole responsibility for the duration of the surgery is to that patient.²

There must be the ability to provide the patient with an appropriate chaperone, as per General Medical Council (GMC) guidance on intimate examinations and chaperones.⁴⁹ When examining a patient, anaesthetists must be sensitive to what the patient may consider as intimate. This could include any examination where it is necessary to touch or even be close to the patient.

A local training module should be provided for anaesthetists in training according to their grade, supervised by a nominated educational lead. This programme should develop understanding of the widespread nature of cardiovascular disease, optimisation and risk stratification, as well as perioperative management. The RCoA revised training curriculum (2021) provides explicit detail of the requirements.³⁰ 

IPS should be staffed by multidisciplinary teams (MDTs) led by appropriately trained autonomously practising anaesthetists (see Glossary). The minimum training requirement for new appointments to IPS lead roles is stage 3 Special Interest Area Pain Medicine training.^1.3

Anaesthesia associates should work under the supervision of a consultant anaesthetist at all times as outlined by the RCoA.^97,93 In some emergency situations, a ratio of one to one and direct supervision may be more appropriate in view of the high incidence of comorbidities, complications and mortality.