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
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
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
The lead obstetric anaesthetist should be made aware of all complaints.
An appropriately trained consultant or autonomously practising cardiac anaesthetist should be wholly and exclusively available at all times, through a formal on-call rota.4 The out of hours duties of the on-call consultant or autonomously practising cardiac theatre anaesthetist should cover only cardiac emergencies, as they can arise and escalate very rapidly, particularly in tertiary referral units. On-call cardiac intensive...
