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Duty of candour guidelines must be followed.¹⁰⁹

There should be ready access to evidence-based guidelines that are appropriate for children on the following topics:

• management of pain, nausea and vomiting
• fluid fasting⁷²
• intravenous fluid management²⁰
• prevention of perioperative venous thromboembolism⁷³
• death of the child in theatre
• protocols for anaesthetic emergencies, including:
  • anaphylaxis⁷⁴
  • malignant hyperthermia
  • difficult airway management
  • airway obstruction
  • resuscitation
  • local anaesthetic toxicity...

When infants and children undergo procedures under sedation alone, recommended published guidance for the conduct of paediatric sedation should be used for example guidance published by the National Institute for Health and Care excellence (NICE) and the Academy of Medical Royal Colleges.^78,79,80

Guidance on pre-procedure pregnancy testing in female patients should be followed.⁸¹

A clinical lead(s) (see Glossary) for anaesthesia in the non-theatre environment should be appointed with adequate time provided within their job plan to develop the service, train staff, and ensure that safety standards are upheld.^2,5,6 The anaesthesia clinical lead for the non-theatre environment should create local consensus guidelines for the staffing of each non-theatre area where anaesthesia is delivered.

An escalation policy should be in place and should be understood by all medical, healthcare professional and managerial staff. This should include the names and method of contact, which should be prominently displayed in appropriate areas. Internal hospital telephone switchboards should have ready access to rotas and methods of contacts.⁷

The non-theatre environment involves multiple clinical teams working together. There should be an anaesthesia clinical lead to coordinate, collaborate, and communicate between clinical teams and to offer effective, explicit leadership.⁵

A dedicated, appropriately trained anaesthetic assistant, who is familiar with that specific environment, should be available in all non-theatre environments where anaesthesia or deep sedation is undertaken by an anaesthetist.^8,9