ECMO support may be used to provide procedural support for selected thoracic surgical procedures such as central airway surgery or severe broncho-pulmonary fistulae – such provision requires specialist care and should be centralised to appropriate centres.
In recent years there has been a trend towards assessment of elective patients in preadmission clinics, typically one to two weeks before surgery. This allows routine paperwork and investigations to be completed before admission, permits ‘same day’ admission and reduces the likelihood of delays or cancellation.30 Anaesthetists should be part of the preadmission clinical pathway, including implementing interventions...
Patients listed for thoracic surgery should have timely access to pre-operative investigations such as lung function and echocardiography, particularly for tumour resection surgery.
Thoracic anaesthesia is a ‘key unit of training’ in both the 2010 intermediate level training in anaesthesia34 and in the newer 2021 Curriculum Stage 2.35of training. Trainee anaesthetists should be of appropriate seniority to be able to benefit from this area of training. Stage 3 training of the 2021 Curriculum also requires trainees to be proficient...
All trainees should be appropriately clinically supervised at all times.37
Trainees should have an appropriate balance between thoracic anaesthesia and ICU training based on their individual requirements.38
Consultant or autonomously practising anaesthetists intending to deliver anaesthesia for thoracic surgery should have received training to a higher level in thoracic anaesthesia. This should be undertaken as a Special Interest Area in Stage 3 training for a period of 3 - 6 months in a recognised training centre.36 Those providing critical care for cardiothoracic surgical patients should...
Consultant or autonomously practising anaesthetists intending to follow a career in paediatric thoracic or cardiothoracic anaesthesia should have higher training in general paediatric anaesthesia of at least one year followed by a specialist training period of an appropriate duration in the subspeciality.
All staff should have access to adequate time, funding and facilities to undertake and update training that is relevant to their clinical practice, including annual mandatory training such as basic life support.
Fellowship posts should be identified to allow additional training for those who wish to follow a career in thoracic anaesthesia to help ensure there are adequate numbers of skilled anaesthetists in the specialty. These should be suitable for trainees who wish to take time out of training programmes, or for those who are post certificate of completion of training. Such...
