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The safe management of unstable patients depends on close liaison between emergency physicians, anaesthetists and intensivists.^50,51 Local collaboration and leadership through committee structure or working groups should ensure the following:

• clear guidelines are easily accessible to all staff regarding fixed contact points for anaesthetic support, channels of escalation, equipment availability, medication use and periprocedural care.⁵² Major...

Information provided preoperatively should include:

• anaesthetic technique; analgesia plan, including regional blockade; any additional procedures (e.g. invasive monitoring, blood transfusion); and planned postoperative care in a critical care environment
• a statement that the ultimate decision making will take place on the day of surgery, according to the needs and safety of the child and as judged by the attending anaesthetist...