Hospitals should provide scheduled local anaesthetic lists, using a dedicated area for initiating and assessing local nerve blocks. Organising cases in this way fosters the development and maintenance of expertise in the anaesthetists and support staff, and minimises delay between cases.
For planned burn and plastic surgery there should be a preoperative assessment clinic organised as described in chapter 2.
There should be specific guidelines for assessing a suspected difficult airway, for example in patients with head and neck malignancy and in reconstructive burn surgery.62
Where major elective reconstructive surgery requiring postoperative critical care provision is undertaken, the funding for, and provision of, these beds should be planned to meet the demands of the service, so that unnecessary cancellations can be minimised.
All major head and neck surgery should be overseen by a named consultant anaesthetist with a subspecialty interest in this area.63
When very long surgical procedures are scheduled on a regular basis, appropriate funding and resources should be in place to support long duration lists.
All anaesthetic equipment should be checked before use in accordance with the Association of Anaesthetists published guidelines.32 Anaesthetic machine checks should be recorded in a log and on the anaesthetic chart.
Anaesthesia for burn and plastic surgery should be included in regular anaesthetic department mortality and morbidity meetings, audit meetings and quality improvement programmes.
Multidisciplinary audit meetings involving surgical teams should be encouraged, where mortality and morbidity should be discussed alongside all serious untoward incidents relative to the service.
