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An appropriately trained consultant cardiac anaesthetist should be available at all times, through a formal on-call rota.⁴

Trained staff and appropriate facilities should be immediately available for emergency resternotomy and bypass. A suitably trained resident anaesthetist should be immediately available for emergencies.⁵

Appropriate local arrangements should be made for the care of postoperative surgical patients being managed outside the main cardiothoracic intensive care unit (ICU), for example postoperative recovery areas and wards.⁶

Perfusion services should be provided by suitably trained and accredited perfusion scientists⁷ and comply with Department of Health guidelines.⁸

Interventional cardiology services increasingly require anaesthesia, critical care and nursing resources depending on procedural complexity and patient morbidity. General anaesthesia may be needed to facilitate complex interventions or required in an emergency for invasive cardiological procedures. Both eventualities require that appropriate anaesthetic staffing, skilled assistance, equipment and monitoring should be available.²

At centres where 24/7 primary percutaneous coronary interventions are performed, and in designated heart attack centres, which include out of hospital cardiac arrest patients, there should be provision for immediate availability of a resident anaesthetist, skilled assistance and appropriate equipment and facilities.

All anaesthetists and anaesthetic assistants should receive systematic training in the use of new equipment. This should be documented.³³

Each unit should have a designated clinical lead (see glossary) anaesthetist for thoracic anaesthetic services. This should be recognised in their job plan and they should be involved in multidisciplinary service planning and governance within the unit.

An appropriately trained consultant anaesthetist should be available at all times, through a formal thoracic or cardiothoracic anaesthetic on-call rota, particularly if lung transplantation is performed.

Wherever thoracic anaesthesia and surgery are performed there should be a resident anaesthetist available at all times.