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...
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.
Complex ophthalmic surgical cases often require specialised anaesthetic input. This may include patients having repeated ophthalmic procedures, long and difficult cases, and those potentially requiring specialist intravenous drug therapy, such as intravenous steroids, acetazolamide or mannitol. An anaesthetist of appropriate experience should have dedicated responsibility for operating lists containing such complex cases.
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
All regional anaesthesia equipment (nerve stimulators, ultrasound machine and infusion pumps) should have user manuals and should be checked prior to use in accordance with the Association of Anaesthetists’ published guidelines alongside regular maintenance and replacement programmes.33. A planned maintenance and replacement programme should be in place.
Anaesthetists need time to cover the following essential points in the more immediate preoperative phase. The anaesthetic room is not usually an appropriate place for this except in an emergency.
Assessment
Children with severe comorbidity 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, as part of the multidisciplinary team.124,125
Preoperative assessment of patients, especially those at very high risk, can benefit from a team approach involving cross specialty advice from anaesthetists, surgeons and intensivists. Early consultation with appropriate medical specialties should occur for appropriate conditions, e.g. acute kidney injury, diabetes mellitus and ischaemic heart disease.14
