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Many ophthalmic patients have significant comorbidities that may require optimisation and co-ordination prior to surgery. There should be a lead anaesthetist (with an appropriate number of programmed activities in their job plan and appropriate secretarial support) for preoperative assessment, who works closely with an appropriately trained preoperative assessment team.^6,7

Where burn services are providing a Burn Centre level of care, there should be a 24/7 rostered availability of ST3 or above specialty registrars or appropriately experienced staff grade, associate specialist and specialty (SAS) doctors and emergency consultants. In Burn Centres that provide paediatric services, there should be a 24-hour rostered availability of consultant paediatric anaesthetists.¹¹

Children currently transition to adult congenital heart disease services at the age of 16–18 years, although transition services are integrated into the care pathway from age 12 years. Anaesthetists should be aware of legislation and good practice guidance relevant to young and vulnerable adults.^45,51

At least one consultant in each department should take the lead in safeguarding/child protection ⁵⁹ and undertake training and maintain core level 3 competencies. The lead anaesthetist for safeguarding/child protection should advise on and co-ordinate training within their department, but will not have responsibility for deciding on management of individual clinical cases.

Guidelines, for example those published by the Association of Paediatric Anaesthetists of Great Britain and Ireland, should be followed for the management of children referred for dental extractions under general anaesthesia.³⁴ Further information on anaesthesia for community dentistry is available in chapter 7.

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  

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...

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...