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Critical care should be considered for all high-risk patients requiring emergency surgery. As a minimum, patients with an estimated risk of mortality of 5% or higher should be considered for critical care and should be reviewed by a consultant surgeon, consultant anaesthetist and consultant intensivist before surgery.^5,130  

To maintain the necessary knowledge and skills, vascular anaesthetists should have a regular commitment to the specialty. Adequate time must be made for them to participate in relevant MDT meetings and continuing professional development (CPD) activities. This should include the facility and resources to visit other centres of excellence to exchange ideas and develop new skills where appropriate.²⁸

It is recommended that individual vascular anaesthetists register with, and contribute to, the UK national audit database (National Vascular Registry), which incorporates a section dedicated to ‘anaesthesia’ as developed between the Vascular Anaesthesia Society of Great Britain and Ireland and partnership organisations.³⁴ The systems needed to provide the necessary data should be available and supported.

Following an adverse event, those involved should be supported appropriately. Expert support services should be signposted and made easy to access, and there should be a regular ‘check in’ from a trusted senior colleague known to and accepted by the anaesthetist or staff affected.^103,104,105

There should be effective governance systems and processes in place to assess, monitor and improve the quality and safety of services with particular reference to local guidelines, national policies such as Prep Stop Block, reviews of adverse events, and record keeping. The Royal College of Anaesthetists has issued quality improvement topics relating to regional anaesthesia.⁶⁴

In isolated units where no anaesthetist or medical emergency team is immediately available, there should be at least one person with advanced life-support training or equivalent.^2,9 A clear and agreed pathway should be in place for isolated units to enable the patient to receive appropriate advanced medical care, including intensive care, in the event of it...

All areas in which ophthalmic anaesthesia is performed should have a reliable supply of the medicines required to deliver safe anaesthesia and sedation. Storage arrangements should be such that there is prompt access to them if clinically required, maintains integrity of the medicines, and ensures compliance with safe and secure storage of medicines regulations.³¹ In addition, anaesthetists and...

Consultant or autonomously practising anaesthetists intending to undertake anaesthesia for cardiac surgery should have received training to a higher level in cardiac anaesthesia for a minimum of one year in recognised training centres.⁴³ Those providing critical care for cardiothoracic surgical patients should have received training as described by the Faculty of Intensive Care Medicine (see Cardiothoracic Critical Care, Guidelines...