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In exceptional circumstances, an anaesthetist working singlehandedly may be called to briefly assist with or perform a lifesaving procedure nearby. This is a matter for individual judgement and a dedicated ODP or anaesthetic nurse should be present to monitor the patient in these exceptional circumstances.¹²¹ This should be for as short a period as possible and the person left...

Preoperative assessment, optimisation, manipulation of patients’ normal drugs and shared decision making in patients with diabetes requires a cross-specialty approach based on national guidance involving anaesthetists, surgeons, diabetes physicians, diabetes inpatient specialist nurses and pharmacists. The development of such teams requires time and resources. This should be recognised and provided.^267,268

An appropriate level of staffing and suitable facilities should be available to deliver a good quality preoperative service. Non-anaesthetist health professionals, such as, specialist nurses, pharmacy staff, allied health professionals and Anaesthesia Associates (AAs) add considerable value to the service.^42,46,47

Scheduled lists that are planned to take longer than three sessions (e.g. where a patient requires prolonged time in theatre) must be staffed appropriately to ensure that no single anaesthetist works longer than three elective sessions. Adequate rest periods during sessions must be provided. ^{31, 32, 33}

Departments should consider having a health and wellbeing lead who has access to adequate expertise and resources.⁴³,⁴⁸  The RCoA and the Association of Anaesthetists have published a model job description for this role. ⁴⁹

Information should be made available to patients that gives details of the surgery and local and general anaesthesia for ophthalmic procedures, as well as advice on what to expect on the day of admission. The Royal College of Anaesthetists and the Royal College of Ophthalmologists have a range of booklets available on their websites to help to inform patients.^55,56,57

All anaesthetists and anaesthetic assistants as well as ODPs should receive systematic training in the use of new regional anaesthesia equipment. Provision and receipt of training should be clearly documented. Staff should not use regional anaesthesia equipment unless appropriately trained. There should be a suitable induction policy for new staff and when new equipment is introduced, with a record of...

Patients undergoing regional anaesthesia should undergo preoperative preparation, where there is the opportunity to assess medical fitness and impart information about the procedure. An individualised risk-benefit assessment and discussion should occur with every patient considering regional anaesthesia. Relevant guidance should be followed where appropriate based on the patient, the procedure and the specific regional technique e.g. Association of Anaesthetists guidance...

RA-UK recommend that, under certain strict criteria and as defined in RA-UK supervision guidelines, intraoperative patient monitoring may be delegated to a suitably trained health care worker who has been specifically trained in patient monitoring according to Association of Anaesthetists guidelines. This recommendation pertains to awake surgery under peripheral regional anaesthesia but excludes patients undergoing shoulder surgery in the deck...

A consultant or autonomously practising anaesthetist should be available to review an individual patient’s suitability for day surgery and to assist with preoperative optimisation, in discussion with medical specialists as appropriate. A referral service for nurses or appropriately trained allied health professionals to allow complex patients to have anaesthetic review should be developed.^5,12,13