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Facilities should be available for the storage, administration and routine monitoring of immunosuppressive medication.

Cardiac anaesthetists should be familiar with the normal physiological effects of pregnancy and the general principles of obstetric anaesthesia.⁴³

Where cardiac surgery is scheduled to occur immediately after caesarean section, there should be early involvement of obstetricians, specialist obstetric anaesthetists, neonatal paediatricians and midwifery services.

Equipment, services and facilities should be equivalent to those found in an obstetric unit.⁴⁴

Whenever possible, escalation in care should ideally not lead to the separation of mother and baby.

A multidisciplinary team should agree and document plans in advance for the peripartum management for patients with known congenital or acquired cardiac disease. Staff and facilities should be available for monitored or operative delivery and for managing acute decompensation.

A subgroup of patients with chronic thromboembolic pulmonary hypertension (CTEPH) will benefit from surgery and thise condition should be managed in designated national centres. Currently only one UK centre provides specialist surgical intervention for patients with CTEPH.

The use of ECMO for adult patients with severe respiratory failure is commissioned by the NHS in a small number of specialist centres. The use of ECMO for adult patients with cardiovascular collapse is currently commissioned by the NHS mainly in cardiothoracic transplant centres as a bridge to transplant. An increasing number of non-transplant cardiothoracic and heart attack centres are...

Anaesthetists should be aware of the risks of exposure to ionising radiation in cardiac catheterisation laboratories and should ensure that they use protective garments and screens and wear exposure monitoring devices if requested to do so.⁴⁶

The use of dedicated anaesthetic monitoring equipment, in addition to any monitoring used by cardiologists, is recommended. A remote or slave anaesthetic monitor display should be available to cardiologists.