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Anaesthetists providing sedation for dental procedures should follow the guidance on safe sedation published by the Academy of Medical Royal Colleges and Intercollegiate Advisory Committee on Sedation for Dentistry (IACSD).^35,36,37

Informed consent may not be possible for adults who lack the mental capacity to make decisions for themselves; such patients should not be asked to sign a consent form if they do not have the legal capacity to do so. Standard operating procedures must be compliant with the Mental Capacity Act 2005.⁴⁰ A high level of integrity should be...

Patients awaiting complex head and neck surgery (for benign or malignant pathology), or with significant comorbidities, should be seen in the preassessment clinic by an experienced anaesthetist who ideally will be involved in their perioperative pathway.²⁴

Short and long term outcomes in head and neck cancer patients can be improved by certain lifestyle changes such as cessation of smoking, alcohol reduction and improved nutrition.²⁴ The preoperative assessment clinic should be used as an opportunity to implement these lifestyle changes, with access to the appropriate support services (e.g. dietetics, smoking cessation services) when required.

Access to radiological imaging should be available preoperatively to aid in the identification and management of the difficult airway.

Where major head and neck surgery is performed, there may be a regular requirement for elective level 2 and level 3 critical care facilities. This should be available in the same hospital for those trusts or boards providing complex reconstructive procedures.⁵

When the postoperative destination is a level 2 critical care unit, patients should remain in the postoperative care unit until they meet discharge criteria, including having regained a sufficient level of consciousness.

When fibreoptic scopes are used in head and neck surgery, the general principles for scope decontamination, as outlined by the Department of Health, must be followed.²⁶

Facilities should be available, or transfer arrangements should be in place to allow for the overnight admission of patients who cannot be treated as daycases and for those patients who require unanticipated admission to hospital.

Wherever possible, patients who have undergone airway related surgery should be cared for in the early postoperative period on a dedicated head and neck surgery ward with adequate levels of medical and nursing staff who are familiar with the recognition and management of airway related problems.^4,10