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Simple procedures such as dental extractions, tonsillectomy and adenoidectomy, and the insertion of grommets are examples of surgery suitable to be performed in a general hospital setting.

Where possible surgery should be postponed until after delivery. If this is not possible, for example in cases of head and neck cancer, a multidisciplinary team approach is highly recommended, typically involving anaesthetists, surgeons, oncologists, obstetricians, midwives and paediatricians and, in cases of thyroid malignancy, endocrinologists.

Sleep studies and a trial of continuous positive airway pressure (CPAP) are recommended or should be considered, where possible, prior to elective surgery in order that appropriate services and planning may be allocated to them.²⁹

Postoperative airway issues can occur even following minor surgical procedures, and these should be anticipated and planned for.^30,31 There may be a need to consider elective postoperative care in an appropriate critical care unit or a specialist postoperative ward.^12,32

When providing head and neck anaesthesia services for morbidly obese patients (BMI ≥40), a number of special requirements will need to be considered.¹²

Obesity hypoventilation syndrome (Pickwickian syndrome) is associated with a higher risk of perioperative complications than OSA, and this should be given due consideration in obese patients with or without a STOP-Bang score >3.³⁵

All personnel involved with TORS should be appropriately trained, including knowledge of how to perform an emergency dedock procedure (see glossary). An emergency dedock should be regularly rehearsed by the team, and discussed as part of the briefing prior to TORS.

Consideration should be given to anaesthetic equipment specific for TORS, for example extra-length anaesthetic circuit, patient eye protection, tracheal-tube fixation, laser safety and dental protection.

General anaesthesia for dental procedures should be administered only by anaesthetists in a hospital setting as defined by the Department of Health report reviewing general anaesthesia and conscious sedation in primary dental care.³

Guidelines, for example those published by the Association of Paediatric Anaesthetists of Great Britain and Ireland, should be followed for the management of children referred for dental extractions under general anaesthesia.³⁴ Further information on anaesthesia for community dentistry is available in chapter 7.