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After major thoracic surgery, patients should be transferred to an appropriately sized, equipped and staffed post-anaesthetic recovery area. Planned or emergency access to intensive or high-dependency care should be available.¹¹

Non-invasive ventilation facilities should be available in the immediate postoperative period, for example bilevel positive airway pressure (BiPAP), CPAP and high-flow nasal oxygen therapy (HFNO). HFNO should be available in theatres for induction and support of anaesthesia as required.¹²

Thoracic surgery units should develop an enhanced recovery after surgery programme.^13,14

Preoperative assessment clinics should be established to optimise patient preparation for surgery and reduce same day cancellations. Smoking cessation support should be available to all thoracic patients.

The level of staffing should be sufficient for the consultant leading the emergency anaesthesia team to be able to provide a continuous emergency anaesthesia service in the theatre complex without interruption. Other service requirements, e.g. remote sites, trauma calls and advice should be anticipated and managed through local arrangements.²⁵ Anaesthetists assigned to provide cover for emergency lists should not...

A dedicated, skilled anaesthetic assistant should be available in all locations outside the operating theatre where anaesthesia is undertaken by an anaesthetist.^47,48

Anaesthesia Associates (AAs) should work under the supervision of a consultant anaesthetist at all times as outlined by the RCoA.^48,49 In some emergency situations, a ratio of 1:1 may be more appropriate in view of the high incidence of comorbidities, complications and mortality.

Patients receiving emergency anaesthesia care in a non-theatre location should be cared for by anaesthetists with the same level of competency and assistance as those receiving emergency care in the theatre environment. There should be the same access to anaesthetic equipment, monitoring, drugs and personnel as in the theatre environment. Certain circumstances may require additional assistance, and local arrangements should...

Adequate anaesthetic cover should be available to provide general anaesthesia and sedation for diagnostic radiology sessions, including computed tomography (CT) and magnetic resonance imaging (MRI) scans.

There should be sufficient administrative staff to support all aspects of the emergency anaesthesia service.^25,46