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To guide clinical decision-making, cardiopulmonary exercise testing should be considered for patients undergoing aortic surgery to establish functional capacity and the presence and severity of cardiopulmonary disease. Test results may also be helpful in guiding collaborative decision-making as to the most appropriate treatment option for patients.³⁶

Anaesthetists with an appropriate level of training should manage patients undergoing major elective vascular surgery.

In order to maintain the necessary knowledge and skills, vascular anaesthetists should have a regular commitment to the specialty, and adequate time must be made for them to participate in relevant multidisciplinary meetings and continuing professional development (CPD) activities. This should include the facility and resources to visit other centres of excellence in order to exchange ideas and develop new...

Vascular anaesthetists should have the appropriate skills and knowledge regarding invasive cardiovascular monitoring, cardioactive or vasoactive drugs, strategies for perioperative organ protection (renal, myocardial and cerebral), the management of major haemorrhage, and the maintenance of normothermia.⁴¹

Some anaesthetists may have responsibility for management of major vascular surgical cases on an occasional or out-of-hours basis. Departments of anaesthesia should ensure that opportunities are made available for these anaesthetists to maintain appropriate skills and knowledge. Notwithstanding this, all anaesthetists must recognise and work within the limits of their professional competence.

A local training module should be provided for anaesthetists in training according to their grade, supervised by a nominated educational lead. This programme should develop understanding of the widespread nature of cardiovascular disease, optimisation and risk stratification, as well as perioperative management. The RCoA revised training curriculum (2010) provides explicit detail of the requirements.⁴²

Where cardiopulmonary exercise testing is used it is recommended that appropriate training, accreditation and infrastructure is in place to facilitate this.^43,44

Departments should ensure that vascular anaesthetists and support staff are available to provide a year round service. This should include prospective cover for sickness and planned leave.⁴

Where organisational infrastructure is lacking to safely undertake major or complex vascular cases, e.g. where no critical care bed or vascular anaesthetist is available, clinical staff should not be pressured into proceeding with surgery.

Under circumstances where prolonged or complex vascular procedures are scheduled on a regular basis, appropriate agreement, planning, funding and resources should be in place.