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Special considerations for younger children undergoing day case tonsillectomy/ adenoidectomy surgery should be made depending of expertise at the centre and current national guidelines. Skilled preoperative assessment services, including thorough assessment of children with obstructive sleep apnoea (OSA) and experienced anaesthetists and surgeon are required to deliver this safely. Surgery and perioperative care, including care on the post-anaesthetic care unit...

The Royal College of Anaesthetists has published guidance for audits and quality improvement projects in day surgery.⁶ Each day surgery unit should have a system in place for the routine audit of important basic clinical and organisational parameters such as:

• clinical: unplanned inpatient/overnight admissions following surgery, postoperative symptoms (e.g. pain, nausea and vomiting) 
• organisational: non-attendance rates, patients cancelled...

In non-specialist paediatric tertiary centres, having visiting consultant paediatric anaesthetists from specialist tertiary paediatric centres to attend operating lists to provide education and training updates should be considered. These may be part of the arrangements in place within a children’s surgery ODN. The Certificate of Fitness for Honorary Practice may facilitate such placements and provides a relatively simple system for...

An anaesthetic office, located within five minutes’ walk of the delivery suite, should be available to the duty anaesthetic team. The room should have a computer with intra/internet access to specialist reference material and local multidisciplinary evidence based guidelines and policies. The office space, facilities and furniture should comply with the Association of Anaesthetists' standards.⁸¹ This office could...

Anaesthetists should participate in departmental audit and quality improvement projects, using specific, measurable, attainable, relevant and time-bound (SMART) methodology (see Glossary) and consideration of full audit cycles (e.g. plan, do, study, act). This participation should adhere to the standards and principles outlined in the College’s Raising the Standards: RCoA Quality Improvement Compendium.⁵

Anaesthetists need time to cover the following essential points in the more immediate preoperative phase. The anaesthetic room is not usually an appropriate place for this except in an emergency.

Assessment

• Interview and medical case notes review to establish current diagnoses, current medicines and past medical and anaesthetic history.^7,8
• Examination, including airway assessment.
• Review of results of...

Children with severe comorbidity who require emergency anaesthesia should be treated in a specialist paediatric centre. However, if transfer is not feasible, the most appropriately experienced senior anaesthetist should provide anaesthesia and support resuscitation and stabilisation, as part of the multidisciplinary team.^124,125

Preoperative assessment of patients, especially those at very high risk, can benefit from a team approach involving cross specialty advice from anaesthetists, surgeons and intensivists. Early consultation with appropriate medical specialties should occur for appropriate conditions, e.g. acute kidney injury, diabetes mellitus and ischaemic heart disease.¹⁴

Following admission and prior to undergoing a procedure that requires general or regional anaesthesia, all patients should have a preoperative visit by an anaesthetist or suitably trained assistant, ideally a person directly involved with the administration of the anaesthetic.⁵ This should be done to confirm earlier findings or, in the case of the emergency admission, initiate preoperative anaesthetic assessment and care.