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Anaesthesia Associates (AAs) should work under the supervision of a consultant anaesthetist at all times as outlined by the RCoA.^48,49 In some emergency situations, a ratio of 1:1 may be more appropriate in view of the high incidence of comorbidities, complications and mortality.

Postmenarcheal female patients should be made aware of the need for clinicians to establish pregnancy status before surgery or procedures involving anaesthesia. While obtaining and documenting this information is primarily the responsibility of the operating surgeon or paediatrician, anaesthetists may also feel it necessary to confirm that such checks have been performed.⁷³

Complex ophthalmic surgical cases often require specialised anaesthetic input. This may include patients having repeated ophthalmic procedures, long and difficult cases, and those potentially requiring specialist intravenous drug therapy, such as IV steroids, acetazolamide or mannitol. An anaesthetist of appropriate experience should have sole responsibility for operating lists containing such complex cases.

Hospitals should have well integrated arrangements that ensure anaesthetists covering long neurosurgical procedures or overrunning lists are regularly relieved by an appropriate colleague for refreshment and comfort breaks.^8,9,10,11

Patients requiring planned or emergency burn surgery should be cared for by theatre staff with current experience in burn care.¹¹ Anaesthetists who provide emergency care outside burn services should be trained to manage the initial treatment of the patient with severe burns, including timely emergency assessment, resuscitation, and transfer to a burns service.

Patients undergoing lung transplantation may be under the age of 18 years. Anaesthetists must be aware of legislation and good practice guidance relevant to young and vulnerable adults.^45,51 Children undergoing transplantation should be cared for in a paediatric centre.

In all centres admitting children, one anaesthetist should be appointed as clinical lead (see glossary) for paediatric anaesthesia. Typically, they might undertake at least one paediatric list each week and will be responsible for co-ordinating and overseeing anaesthetic services for children, with particular reference to teaching and training, audit, equipment, guidelines, pain management, sedation and resuscitation.

The use of general anaesthesia, sedation and regional anaesthesia for procedures undertaken in the ED should be managed according to guidance from the Academy of Medical Royal Colleges and Royal College of Anaesthetists.^8,9,10,11

The majority of hip fracture patients are >65 years of age and often have multiple comorbidities, some of which may be undiagnosed. Decisions on their treatment should ideally be made using a multidisciplinary team that involves senior anaesthetists, perioperative physicians, orthopaedic surgeons and orthogeriatricians, all with a specific interest in this patient population.⁵⁰

There must be the ability to provide the patient with an appropriate chaperone, as per General Medical Council (GMC) guidance on intimate examinations and chaperones.⁴⁹ When examining a patient, anaesthetists must be sensitive to what the patient may consider as intimate. This could include any examination where it is necessary to touch or even be close to the patient.