A policy should be in place for the management of non-peripartum pregnant patients. This should detail the involvement of the multidisciplinary obstetric team, including midwives, neonatologists and obstetricians, depending on gestational stage.43
Patients who are older and / or frail patients will have different staffing requirements; see section 12 for detailed recommendations.
Multidisciplinary care improves outcomes. Protocol driven integrated pathways guide care effectively, but should be individualised to suit each patient, with emphasis on management of postoperative pain and avoidance of postoperative delirium.44
Perioperative time should be allocated for the work the anaesthetist undertakes on the day of surgery for both preoperative and postoperative care. The times allocated might vary per patient but for most theatre lists, it approximates to one hour per four hours spent in the operating theatre suite or two hours per eight hours in the operating theatre suite.
Every hospital should nominate an anaesthetic lead for obese patients undergoing surgery.45
Medical records should include patients’ weight and body mass index.45
The safe movement and positioning of obese patients may require additional staff and specialised equipment. An operating table, hoists, beds, positioning aids and transfer equipment appropriate for the care of obese patients should be available, and staff should be trained in its use.45 Additional members of staff should be available where necessary, and manual handling should be minimised where possible.
The RCoA and Association of Anaesthetists currently do not support enhanced roles for AAs until the statutory regulation for AAs is in place. Where such role enhancement exists or is proposed, responsibility should be defined by local governance arrangements.112
AAs should always work within an anaesthesia team led by a consultant anaesthetist who has overall responsibility for the anaesthesia care provided for the patient and whose name should be recorded in the individual patient’s medical notes.112
The supervising consultant anaesthetist should be easily contactable and should be available to attend within minutes of being requested by the AAs.112
