A multidisciplinary team (MDT) may be required, and this may include plastic, vascular or neurosurgical surgeons for complex head and neck surgery. Anaesthetists may be required to attend MDT meetings preoperatively, and this should be included in their job plan if it forms a regular commitment.
Access to an emergency operating theatre staffed with appropriate personnel should be available for all cases requiring urgent surgical management, for example obstructed airway or bleeding tonsil.
A clear referral pathway should exist for the eventuality of patients requiring transfer to a regional centre.
There should be at least one three-session operating day per week as required, dedicated to complex head and neck surgery,5 with provision made for adequate rest breaks.
A ‘best interests’ meeting will be needed where an adult (over 16 years old) lacks mental capacity to make significant decisions for themselves and needs others to make those decisions on their behalf.39
Establishing a successful SCD anaesthetic service in hospitals requires suitably trained staff with an understanding of specific perioperative challenges in this group and with experience in the management of shared airways.38
Specialist airway equipment, for example videolaryngoscopes, high frequency jet ventilators, transnasal high-flow humidified oxygen delivery devices and portable ultrasound machines should be included in annual budget planning and procurement processes.17
In addition to routine audit and the reporting of critical incidents, any morbidity relating to airway management should be presented at departmental clinical governance meetings and documented for audit purposes.
As part of a difficult airway follow-up, patients should be informed in writing about any significant airway problem encountered, and be advised to bring it to the attention of anaesthetists during any future preoperative assessment.
