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The use of extracorporeal membrane oxygenation (ECMO) for the management of adults with severe respiratory failure is currently confined to five UK cardiothoracic centres. Anaesthetists often institute ECMO and support retrieval of patients from non-specialist hospitals. Anaesthetists providing ECMO should be suitably trained.⁵⁴

The patients’ anaesthetist should retain overall responsibility for the patient during the recovery period and should be readily available for consultation until the patient is able to maintain their own airway, has regained respiratory and cardiovascular stability and is able to communicate, unless this care has been handed over to another named anaesthetist

Training for anaesthetists to attain basic, intermediate and higher level competencies in pain medicine, as specified by the Faculty of Pain Medicine of the Royal College of Anaesthetists, should be provided. Where higher or advanced pain training is not feasible within an individual hospital, it should be available within the region.⁶⁰

Young people have additional needs and may wish to speak to the anaesthetist or another member of staff without direct parental presence.^65,98 Anaesthetists should make it clear that they are willing to speak with young people on their own, on request.

Trained anaesthetic assistance, theatre staff and appropriate facilities should be immediately available for emergency resternotomy and cardiopulmonary bypass. A suitably trained resident anaesthetist should be immediately available for theatre emergencies and to assist the on-call consultant or autonomously practising cardiac anaesthetist in theatre out of hours.⁵

The use of extracorporeal membrane oxygenation (ECMO) for the management of adults with severe respiratory failure is centralised in a number of specialist cardiothoracic centres. Anaesthetists often institute ECMO and support retrieval of patients from non-specialist hospitals. Anaesthetists providing ECMO should be suitably trained.²⁹

An anaesthetist should be physically present when a general anaesthetic is administered. In exceptional circumstances, anaesthetists working singlehandedly may be called on briefly to assist with or perform a lifesaving procedure nearby. This is a matter for individual judgement, and a dedicated anaesthesia assistant should be present to monitor the unattended patient.¹¹

The anaesthetist should be with the patient at all times while the patient is anaesthetised. In hospitals employing AAs, this responsibility may be delegated to an AA, supervised by a consultant anaesthetist in accordance with the scope of practice for AAs.^118,121

Wherever possible, anaesthesia in remote ophthalmic surgical sites should be delivered by an appropriately experienced consultant or autonomously practising anaesthetist. Where a trainee or non-consultant grade is required to provide anaesthetic services at a remote site, the recommendations of the Royal College of Anaesthetists should be followed.¹⁰