Search

At least one consultant in each department should take the lead in safeguarding/child protection and undertake training and maintain core level 3 competencies.⁶¹ The lead anaesthetist for safeguarding/child protection should advise on and co-ordinate training within their department but will not have responsibility for deciding on management of individual clinical cases.

Drug labels should be used to identify syringes and infusions that contain medications.^24,35 A robust system of communication between the anaesthetists, nursing staff and proceduralists, including confirmation of medications, should be in place to avoid miscommunication and miscalculation errors.²⁸

All patients with complex needs should have a suitable preoperative assessment and multidisciplinary planning and an anaesthetist should be involved in the best-interest discussions regarding individual risk.^43,45 Learning disability liaison teams or equivalent should be involved early in care planning.

Patients receiving emergency anaesthesia care in a non-theatre location should be cared for by anaesthetists with the same level of competency and assistance as those receiving emergency care in the theatre environment. Certain circumstances may require additional assistance; local arrangements should allow sufficient personnel and resources to support this assistance.^85,99

The location for undertaking emergency paediatric procedures is often a pragmatic compromise but should, as far as is possible, replicate the location and conditions of paediatric care delivered in the elective setting. Anaesthesia for children should be undertaken or supervised by anaesthetists who have undergone appropriate training and have maintained their competence.^136,165

Critical care should be considered for all high-risk patients requiring emergency surgery. As a minimum, patients with an estimated risk of mortality of 5% or higher should be considered for critical care and should be reviewed by a consultant surgeon, consultant anaesthetist and consultant intensivist before surgery.^5,130  

To maintain the necessary knowledge and skills, vascular anaesthetists should have a regular commitment to the specialty. Adequate time must be made for them to participate in relevant MDT meetings and continuing professional development (CPD) activities. This should include the facility and resources to visit other centres of excellence to exchange ideas and develop new skills where appropriate.²⁸

It is recommended that individual vascular anaesthetists register with, and contribute to, the UK national audit database (National Vascular Registry), which incorporates a section dedicated to ‘anaesthesia’ as developed between the Vascular Anaesthesia Society of Great Britain and Ireland and partnership organisations.³⁴ The systems needed to provide the necessary data should be available and supported.

Children currently transition to adult congenital heart disease services at the age of 16–18 years, although transition services are integrated into the care pathway from 12 years of age. Anaesthetists should be aware of legislation and good practice guidance relevant to young and vulnerable adults.^35,41

Following admission and prior to undergoing a procedure that requires general or regional anaesthesia, all patients should have a preoperative visit by an anaesthetist, ideally a person directly involved with the administration of the anaesthetic.⁴² This should be done to confirm earlier findings or, in the case of emergency admission, initiate preoperative anaesthetic assessment and care.