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Policies should be in place for the safe administration of anxiolytic premedication within the admissions area or anaesthetic room.^44,45,46

Any preprocedure sedation that occurs outside a normal clinical environment should have all the anaesthetic equipment that is required for monitoring and airway support plus a trained assistant available. There should be formal training in the pathways used.

Bespoke plans should be clearly communicated and documented with contingencies and escalation.

If a patient with additional needs requires multiple procedures to be conducted during a single anaesthetic, appropriate logistical planning should be considered, including arrangements for safe transfer to other non-theatre sites where applicable.

Safe recovery of patients with learning disabilities should be planned in advance. Patients should ideally be recovered in an area with lower levels of noise and lighting and should have a familiar presence, such as their carer, present.⁴³

Appropriate exposure should be given to anaesthetists during their training to develop skills in reasonable adjustments and anxiolysis. Allied professionals specialising in this area should also be given training.^44,45

Children should always be managed in accordance with RCoA and Association of Paediatric Anaesthetists of Great Britain and Ireland recommendations.

Each facility should develop written policies, designating the types of paediatric operative diagnostic and therapeutic procedures requiring anaesthesia.

The paediatric anaesthetist should consider the patient’s age and physical capacity, the complexity of the procedure and the status of the surgical facility before administering anaesthesia. Children with learning and/or communication difficulties requiring sedation or anaesthesia should be cared for as per the recommendations of GPAS Chapter 10: Guidelines for the Provision of Paediatric Services.³⁹

Irrespective of the site of care delivery (theatre or non-theatre), children should receive the same standard of anaesthetic care or sedation as applied to procedures performed in theatre.⁴⁰