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The experience and expertise of the anaesthetist assessing the patient preoperatively should be appropriate for the complexity and level of risk of the patient.⁴⁶ The decision to operate on high risk patients should be made at a senior level, involving surgeons and those who will provide intra and postoperative care.^3,14,33

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 being required.²

Patients exhibit extremely wide variation in response to drugs used for sedation. Coupled with this uncertain pharmacodynamic response, patient access during ophthalmic surgery is often very limited and airway manipulation may be difficult should a state of deep sedation occur. In view of these safety concerns, administration of intravenous sedation during ophthalmic surgery should only be undertaken by an anaesthetist...

Anaesthetists should be aware of legislation and good practice guidance⁴⁵ relevant to children and according to the location in the UK.^46,47,48,49 These documents refer to the rights of the child, child protection processes and consent.

Fellowship posts should be identified to allow additional training for those who wish to follow a career in cardiac or thoracic anaesthesia to help ensure there are adequate numbers of skilled anaesthetists in the specialty. These should be suitable for trainees who wish to take time out of training programmes, or for those who are post certificate of completion of...

Each DSU should have a clinical director or specialty lead. This will often, but not always, be an anaesthetist with some management experience. The role of the clinical director is to champion the cause of day surgery and ensure that best practice is followed. This role may involve the development of local policies, guidelines and clinical governance and should be...

Anaesthetists with a job plan that includes obstetric anaesthesia must demonstrate ongoing continuing education in obstetric anaesthesia, and continuing professional development as needed for this aspect of their work.¹⁰⁴ Hospitals have a responsibility to enable this with local teaching where appropriate, and by facilitating access to other education and training.^96,105,106

Elderly patients presenting for elective surgery frequently have pre-existing comorbidities that require careful review and perioperative planning. As such, the preassessment service for elective patients should be consultant led, ideally by anaesthetists with an interest in, and appropriate experience in, delivering anaesthetic care to orthopaedic patients.^{12, 14}

All anaesthetists should be fully familiarised with all remote areas of anaesthetic provision, e.g. as part of their induction process, prior to undertaking anaesthetic procedures in that location.⁵⁶ This should include familiarisation with the layout of the hospital and the location of emergency equipment and drugs, access to guidelines and protocols, information on how to summon support/assistance, and assurance...

In order to maintain the necessary repertoire of skills, consultant anaesthetists and SAS doctors providing a head and neck service should have a regular commitment to the specialty, and adequate time should be made available for them to participate in a range of relevant continuing medical education activities, including simulation, human factors and team training.^7,43,44