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There should be multidisciplinary input for the preoperative assessment of high risk patients such as patients with cognitive disorders, chronic kidney disease, diabetes mellitus and ischaemic heart disease.^50,65 The anaesthetist should be involved in preoperative optimisation and prehabilitation plans.^60,62

All anaesthetists who provide elective or emergency care for infants, children or young adults should have training in advanced life support that covers their expected range of clinical practice and responsibilities.^52,53 These competencies should be maintained by annual training that are ideally multidisciplinary and scenario based.⁵⁴

Intermediate level training as set out in the RCoA 2010 Curriculum⁴¹should be an essential criterion and higher level training a desirable criterion in the person specification for a consultant or autonomously practising anaesthetist with ophthalmic anaesthetic sessions in the job plan. For candidates who are trained on the RCoA 2021 Curriculum, the special interest area in ophthalmic anaesthesia...

If responsibility for care is transferred from one anaesthetist to another, a ‘handover protocol’ should be followed, during which all relevant information about the patient’s history, medical condition, anaesthetic status, and plan should be communicated.⁶

Routine anaesthesia monitoring according to the Association of Anaesthetists standards of monitoring should be available for all areas where anaesthesia is undertaken.¹⁰² Departments should follow national clinical guidelines for the use of monitoring equipment, or local guidelines when national guidelines are not available.

An anaesthetist should preoperatively assess all patients undergoing emergency surgery who require anaesthesia. This should take place outside of the theatre complex if possible and adequate time should be available for this to occur as clinical urgency allows.¹⁸¹

If no anaesthetist is present in theatre, an appropriately trained anaesthetic nurse, ophthalmic theatre nurse or operating department practitioner (ODP) should be present to monitor the patient during establishment of local anaesthesia and throughout the operative procedure. This should be their sole responsibility.²

The Anaesthesia Associates (AAs) should work at all times within an anaesthesia team led by a consultant anaesthetist who has overall responsibility for anaesthesia care of the patient and whose name should be recorded in the individual patient’s medical notes.³

Educational opportunities for trainees in MTC and TU will undoubtedly occur out of hours due to the nature of trauma. Hospitals in which trainee anaesthetists work a full or partial shift system should consider providing additional consultant programmed activities to allow training and supervision to take place in the evening.