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Interventional cardiology services increasingly require anaesthesia, critical care, perfusion, operating department practitioners and nursing resources, depending on procedural complexity and patient morbidity. General anaesthesia is frequently needed to facilitate complex interventions or required in an emergency for invasive cardiological procedures. Both eventualities require that appropriate anaesthetic staffing, skilled assistance, equipment and monitoring should be available.2
At centres where 24/7 primary percutaneous coronary interventions are performed, and in designated heart attack centres that include out of hospital cardiac arrest patients, there should be provision for immediate availability of a resident anaesthetist, skilled assistance and appropriate equipment and facilities.
The same level of equipment should be available for cardiac surgery as is available in general theatres as specified in Chapter 3. Additional specialty-specific monitoring is required and is detailed below.9
The standard of monitoring in the operating theatre should allow the conduct of safe anaesthesia for surgery as detailed by the Association of Anaesthetists standards of monitoring.10
During the transfer of the patient at the end of surgery to the postoperative care unit, there should be access to electrocardiogram (ECG), invasive blood pressure monitoring, pulse oximetry, disconnection alarm for any mechanical ventilation system, fractional inspired oxygen concentration and end-tidal carbon dioxide.10,11
Access to cardiac output monitoring should be available for high-risk cardiac patients perioperatively.12
Physiological monitoring alarm settings should be appropriate for the specific procedure.13
A fluid warmer allowing the transfusion of warmed blood products and intravenous fluids should be available and should be used.14
A rapid infusion device should be available for the management of major haemorrhage.14
A cell salvage service should be available for patients in whom blood loss is anticipated and for those who decline blood products. Staff who operate this equipment should receive training and should use it frequently to maintain their skills.
