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All members of clinical staff working within the recovery area should be certified immediate life support providers and mandatory training should be provided.^7,13

For children, staff should hold an equivalent paediatric life-support qualification.^7,13

It is the responsibility of those leading departments of anaesthesia, together with their constituent consultants or autonomously practising anaesthetists, to ensure that AAs work under the immediate supervision of a consultant or autonomously practising anaesthetist at all times. ¹⁴

There should be a dedicated trained assistant (i.e. an operating department practitioner or equivalent) in every theatre in which anaesthesia care is being delivered by AAs.¹⁵

Clinical governance is the responsibility of individual institutions and, for AAs, this should follow the same principles that apply to medically qualified anaesthetists, ensuring:¹⁵

• training that is appropriately focused and resourced
• supervision and support in keeping with practitioners’ needs and practice responsibilities
• practice centred audit and review processes.

In areas where ophthalmic surgery is performed, resuscitation equipment and drugs should be immediately available, including a standardised resuscitation trolley and defibrillator. The manufacturer’s instructions must be followed regarding use, storage, servicing and expiry of equipment and drugs.⁸

Where paediatric ophthalmic surgery is performed, appropriate paediatric anaesthetic equipment and monitoring should be available. Equipment should be checked regularly.¹⁶

Anaesthetists should be trained in the use of, and be familiar with, all equipment that they use regularly. The anaesthetist has a primary responsibility to check such equipment before use.¹⁷

Where lasers are in use for ophthalmic surgery, the correct safeguards must be in place.^18,19

Where possible, ophthalmic surgery should be postponed until after delivery. When this is not possible, guidelines on anaesthetising pregnant patients should be followed (e.g. use of left lateral tilt after 16 weeks of gestation).⁷Local anaesthesia, with or without anxiolytic sedation, is usually preferable to general anaesthesia.