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A multidisciplinary team approach is highly recommended, typically involving anaesthetists, obstetricians, surgeons, paediatricians and midwives.^43,44,45

Anaesthetists should be part of the multidisciplinary team engaged in development and implementation of enhanced recovery programmes in cardiac and thoracic surgery.^59,60,64

The RCoA and Association of Anaesthetists currently do not support enhanced roles for AAs until the statutory regulation for AAs is in place. Where such role enhancement exists or is proposed, responsibility should be defined by local governance arrangements.¹¹²

Anaesthetists should have specialised knowledge of the effect of concurrent medications, anaesthetic agents and anaesthetic techniques on the conduct and efficacy of ECT, as well as the specific anaesthetic contraindications.^45,47

Where possible surgery should be postponed until after delivery. If this is not possible, for example in cases of head and neck cancer, a multidisciplinary team approach is highly recommended, typically involving anaesthetists, surgeons, oncologists, obstetricians, midwives and paediatricians and, in cases of thyroid malignancy, endocrinologists.

Patients awaiting complex head and neck surgery (for benign or malignant pathology), or with significant comorbidities, should be seen in the preassessment clinic by an experienced anaesthetist who ideally will be involved in their perioperative pathway.²⁴

Vascular anaesthetists should have the appropriate skills and knowledge regarding invasive cardiovascular monitoring, cardioactive or vasoactive drugs, strategies for perioperative organ protection (renal, myocardial and cerebral), the management of major haemorrhage, and the maintenance of normothermia.⁴¹

In a designated major trauma centre, the receiving trauma team should include an anaesthetist with appropriate airway and damage control resuscitation competencies to manage trauma patients.^48,49

Anaesthetists should facilitate surgery within 36 hours of a hip fracture.⁵¹ Surgery should be delayed only if the benefits of additional medical treatment outweigh the risks of delaying surgery. The risks of delay associated with pain and immobility contribute to poor outcomes to a far greater extent than correction of an abnormality to a particular numerical value.⁴⁵

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