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Anaesthetists should be involved in audit and quality improvement cycles, preferably using a ‘rapid cycle’ quality improvement approach. This approach benchmarks standards of care and may be an effective change driver. It is also an excellent way of providing evidence of good practice as defined by the GMC, and mapping the contribution that individuals make to any service within their...

Many ophthalmic patients have significant comorbidities that may require optimisation and coordination prior to surgery. There should be a lead anaesthetist (with an appropriate number of programmed activities in their job plan and appropriate secretarial support) for preoperative assessment, who works closely with an appropriately trained preoperative assessment team.^6,7 

Clinical governance is the responsibility of individual institutions and, for AAs, this should follow the same principles that apply to medically qualified anaesthetists, ensuring:¹⁵

• training that is appropriately focused and resourced
• supervision and support in keeping with practitioners’ needs and practice responsibilities
• practice centred audit and review processes.

Following an adverse event, those involved should be supported appropriately. Expert support services should be signposted and made easy to access, and there should be a regular ‘check in’ from a trusted senior colleague known to and accepted by the anaesthetist or staff affected.^103,104,105

There should be effective governance systems and processes in place to assess, monitor and improve the quality and safety of services with particular reference to local guidelines, national policies such as Prep Stop Block, reviews of adverse events, and record keeping. The Royal College of Anaesthetists has issued quality improvement topics relating to regional anaesthesia.⁶⁴

Multimodal analgesia should be used, including regional anaesthesia. Opioid analgesia can be used if required, but the patient should be given advice regarding observing the infant for signs of excessive drowsiness. Additional advice for prescribing for breastfeeding patients can be found in the guideline from Association of Anaesthetists Guidelines on breastfeeding and sedation in breastfeeding women.⁴⁵

Transfer of children to specialist centres is usually undertaken by regional paediatric emergency transfer services. Time critical transfers such as neurosurgical emergencies may need to be transferred by the referring hospital. Local guidelines should be in place for the management of such transfers and the most experienced anaesthetist with appropriate skills, together with a trained assistant, should accompany the child.¹²⁶