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Anaesthetists should help to organise and participate in regular multidisciplinary courses and ‘skills and drills’ for emergencies.^{8,25,88,129,130,131}

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. This should take place at the earliest possible opportunity to maximise the time available for optimisation and shared decision making.⁵

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 

Anaesthetists should be aware of legislation and good practice guidance relevant to children and according to the location in the UK.^{35,36,37,38,39}

Patients undergoing heart or 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.^35,41 Children undergoing transplantation should be cared for in a paediatric centre.

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

Anaesthetists should be aware of legislation and good practice guidance²¹ relevant to children and according to the location in the UK.^22,23,24,25

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.

The output from consultations with patients at increased risk of mortality or morbidity must be documented in the patient’s medical notes. In addition, mechanisms for clear communication of these consultations to patients, anaesthetists, surgeons, general practitioners and other healthcare workers should be in place.^6,54

There should be a dedicated trained assistant (i.e. an ODP, anaesthetic nurse or equivalent) who holds a valid registration with the appropriate regulatory body, immediately available in every location in which anaesthesia care is being delivered, whether this is by an anaesthetist or an AA.^41,118