Each unit should have a designated clinical lead (see glossary) anaesthetist for thoracic anaesthetic 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 anaesthetist should be available at all times, through a formal thoracic or cardiothoracic anaesthetic on-call rota, particularly if lung transplantation is performed.
Wherever thoracic anaesthesia and surgery are performed there should be a resident anaesthetist available at all times.
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 cases 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 cases may necessitate anaesthetic involvement in multidisciplinary team meetings and this activity should be reflected in job plans.
Consultant anaesthetists in cardiac and thoracic 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.
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
