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It is recognised that equipment for neurosurgical patients can be expensive; this should be considered through business models.

Availability of two consultant anaesthetists, or a consultant and senior trainee or SAS doctor, should be considered for more complex procedures, such as thoracoabdominal aortic aneurysm repair.²

Continuity of care should be a priority in prolonged procedures and when this is not possible, a formal documented process with some overlap should be in place for handover of clinical care from one anaesthetist to another.³

The complexity of some procedures may necessitate anaesthetic involvement in multidisciplinary team meetings and this activity should be reflected in job plans.

Consultant or autonomously practising anaesthetists in cardiac units should be responsible for the provision of service, teaching, protocol development, management, research and quality improvement. Adequate time should be allocated in job plans for these activities.

Each unit should have a designated clinical lead (see Glossary) anaesthetist who is responsible for cardiac anaesthesia services. This should be recognised in their job plan and they should be involved in multidisciplinary service planning and governance within the unit.

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...

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

Appropriate local arrangements should be made for the care of postoperative surgical patients being managed outside the main cardiac intensive care unit (ICU), for example postoperative recovery areas and wards.⁶

Perfusion services should be provided by suitably trained and accredited clinical perfusion scientists and should comply with Department of Health guidelines. A suitable number of trained perfusionists should be always available according to the recommendations for standards of monitoring during cardiopulmonary bypass.⁷