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Difficult tracheal intubation equipment, waveform capnography and training for the management of the emergency airway should be available.^9,58,59

Sedation techniques are frequently used in the non-theatre environment along with anaesthetic techniques. Sedation is regarded as a core competency for anaesthetic practice and training/exposure should be provided to current standards at basic, intermediate and higher levels.^2,60

Hospitals should consider involving an anaesthetist in the training of non-anaesthetists in the provision of safe sedation.

Patient safety is, as always, of paramount importance, and particular attention should be paid to teamwork, communication and the use of checklists when working in less familiar environments. At the team briefing, an explicit plan should be agreed for requesting help if required, recognising the risk of, and preparing adequately for, high blood loss, and life-threatening loss of the airway...

Many patients undergoing elective procedures outside the operating theatre can be managed as day cases and should be assessed accordingly in conjunction with local guidelines. More complex patients require assessment to at least the same standard as that required for surgery.^62,64

Hospitals should have a system for multidisciplinary involvement in reporting and regular audit of critical incidents and near misses.

Environmental hazards such as radiation exposure, magnetic resonance (MR) fields and lack of a scavenging system should be considered by staff before the start of each list. Volatile agent scavenging canisters, air-oxygen mixtures and avoidance of nitrous oxide can mitigate environmental risks. Pregnant personnel may be particularly at risk in these environments and should follow local occupational health policy.

In remote off site locations, such as psychiatric hospitals where anaesthesia is provided for ECT, advanced plans should be made to manage patient transfer if required.

If there is any concern about the safety of the procedure being undertaken at a remote location, for example ECT in a psychiatric hospital, then arrangements should be made to perform the procedure in an operating theatre environment.

Documentation, to the standard used in the operating theatre, should be kept for all cases and this should include the grade and specialty of the doctor performing and supervising the anaesthetic along with the name of the supervising consultant designated to provide direct or indirect advice.¹⁹ Access to the electronic patient record should be available at all remote sites.