Search

Previous ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) orders are not necessarily a contraindication to surgery and should be reviewed on a case by case basis by the multidisciplinary team, in discussion with the patient and their next of kin, prior to anaesthesia if at all possible.^115,116

There should be adequate critical care facilities to allow the timely admission of high risk general surgical patients.¹⁴ Preoperative risk stratification should inform the decision making process for critical care admission.^1,72

Critical care should be considered for all patients requiring emergency surgery. There should be close preoperative liaison and communication between the surgical, anaesthetic and critical care teams, with the common goal of ensuring appropriate safe care in the best interests of the patient.³³

All high risk patients should be considered for critical care. As a minimum, patients with an estimated risk of death of ≥10% should be admitted to a critical care location (unless there is a contraindication).³ The 10% threshold for risk of death is historical and should be perceived as an absolute minimum standard. The exact percentage mortality risk that...

Hospital level audit data should be examined to determine whether national standards for postoperative critical care admission are being adhered to. Where compliance is poor, a change of local policies and reconfiguration of services should be considered, to enable all high risk emergency laparotomy patients to be cared for on a critical care unit after surgery.¹   

Anaesthesia for children should be undertaken or supervised by senior anaesthetists who have undergone appropriate training. In the UK, all anaesthetists with a CCT or equivalent will have obtained higher paediatric anaesthetic training. There will be anaesthetists who have acquired more advanced competencies, thus allowing provision of a more extensive anaesthetic service, and those competencies should be maintained. Unless there...

Each hospital should have a written definition of age thresholds and the types of procedure for elective and emergency work, including imaging, which can be provided locally. Complex children, e.g. ASA 3 with significant comorbidity, should be discussed with the carers and referred to a tertiary centre if the local infrastructure cannot meet their needs.^21,22

In each hospital providing neuroanaesthesia, a neuroanaesthetist should be appointed as the clinical lead (see glossary) to manage service delivery. Adequate time for this role should be included in the lead’s job plan.

Children should be separated from, and not managed directly alongside adults throughout the patient pathway including in waiting rooms, preassessment clinic rooms and theatre areas, including anaesthetic and recovery areas, as far as possible.¹⁹ These areas should be child-friendly.

Hospitals should define the extent of emergency surgical provision for children and the thresholds for transfer.