Search

Preoperative assessment, optimisation and shared decision making in patients with multiple comorbidities, frailty or cognitive impairment require a cross specialty approach involving anaesthetists, surgeons, geriatricians, pharmacists and allied health professionals. Liaison with a clinical pharmacist in the perioperative period will enable optimisation of medicines and improved management of the patients’ non-surgical comorbidities during this time. The development of such teams...

Some aspects of preanaesthetic assessment and preparation of the emergency patient differ from those of the elective patient. These include severity of illness, fluctuating condition of the patient, and the 24/7 nature of emergency work. Staffing levels and seniority of anaesthetists should be adequate to enable preanaesthetic planning and assessment that is appropriate to the patient’s risks associated with surgery...

Appropriate staffing levels and skill mix should be provided in all units, multispecialty general hospitals, isolated units and large single specialty centres, delivering ophthalmic anaesthesia. For most operating sessions, this should include surgeon, anaesthetist, two theatre trained scrub practitioners, one trained nurse or operating department practitioner to assist with local anaesthesia/patient monitoring, and one theatre support worker/runner.^2,3

All anaesthetists who provide elective or emergency care for infants, children or young adults should have advanced training in life support that covers their expected range of clinical practice and responsibilities.^49,50 These competencies should be maintained by annual training that are ideally multidisciplinary and scenario based.⁵¹

Although separate written consent for anaesthesia is not mandatory in the UK, there should be a written record of all discussions, including those of the requesting clinician, with patients undergoing sedation or anaesthesia for diagnostic procedures such as MRI scans. Discussion should include methods of induction, associated risks, side effects and potential benefits of the procedure. It is not the...

Day surgery should be a consultant or autonomously practising anaesthetist/surgeon-led service with a dedicated clinical lead or clinical director who has programmed activities allocated to the role within their job plan. The role of the clinical director is to champion the cause of day surgery and to ensure that best practice is followed. This role may involve the development of...

Agreed local guidelines should be in place and implemented on the following:

• compliance with best practice anaesthetic management protocols for hip fracture as recommended by the Association of Anaesthetists.^46,61
• tailored World Health Organization (WHO) safety checklists to discuss the requirement for use of bone cement  
• preoperative assessment for treatment escalation and cardiopulmonary resuscitation
• older people (>65...