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The establishment of regional networks for paediatric anaesthesia should facilitate joint CPD and refresher training in paediatric anaesthesia and resuscitation. Where appropriate, joint appointments may be considered, allowing designated anaesthetists from non-specialist centres a regular commitment within a specialist centre in order to maintain and develop skills.

Parents and carers should be involved throughout the care process. With the agreement of the anaesthetist in charge of the case on the day, they should be able to accompany children to the anaesthetic room, remain present for induction of anaesthesia and be able to gain easy access to the recovery area. In special circumstances, such as with some small...

All anaesthetists, Anaesthesia Associates (AAs) and anaesthetic assistants, whether permanent or locum/agency staff, should undergo an appropriate induction process, which includes the contents of relevant policies and Standard Operating Procedures.^1,2 This should be documented.

In a true emergency situation involving a child requiring urgent neurosurgery for a deteriorating condition admitted to an ‘adult only’ neurosurgical service, the most appropriate surgeon, anaesthetist and intensivist available would be expected to provide life saving care, including emergency resuscitation and surgery.³⁰

There should be a dedicated trained assistant, i.e. an operating department practitioner (ODP) or equivalent, who holds a valid registration with the appropriate regulatory body, immediately available in every location in which anaesthesia care is being delivered, whether this is by an anaesthetist or a AAs.^3,5

All cardiac and thoracic units should have regular morbidity and mortality meetings. These should have a list of patients to discuss in advance, an attendance register, and minutes with learning points. Consultant anaesthetists should attend these meetings and where possible inclusion in job plans should be considered. Trainees should be encouraged to attend during their attachments.

Perioperative time should be allocated for the work the anaesthetist undertakes on the day of surgery for both preoperative and postoperative care. The times allocated might vary per patient but for most theatre lists, it approximates to one hour per four hours spent in the operating theatre suite or two hours per eight hours in the operating theatre suite.

Anaesthesia departments should make arrangements to allow anaesthetists working solo during long surgical procedures or on overrunning lists to be relieved by a colleague or AA for meal and comfort breaks.^110,111,112

There must be the ability to provide the patient with the appropriate chaperone, as per GMC guidance on intimate examinations and chaperones.¹¹ When examining a patient, anaesthetists must be sensitive to what the patient may consider as intimate, which could include any examination where it is necessary to touch or even be close to the patient.

The anaesthetist should ensure that an adequate supply of oxygen is available before starting any procedure. Many of the sites where anaesthesia is provided outside the main operating theatres do not have piped oxygen; if anaesthesia is provided frequently in such a location, the use of the location should be reviewed or piped oxygen provided.