Anaesthesia outwith the theatre suite

Abstract 

Anaesthesia outside a dedicated operating department can be challenging, and the anaesthetist cannot take for granted easy access to the patient, familiarity with equipment and monitoring, supporting staff who understand the requirements and risks of anaesthesia, or timely support in a crisis. The anaesthetist must take active responsibility for ensuring a good and safe standard of care by applying both competent clinical skills and practised non-technical skills. This is supported by systems of working and organisational governance, which provide staffing in appropriate numbers and skill-mix, equipment, monitoring, facilities for resuscitation, and safe working practices for controlling hazards and delivering safe patient care. For sick or traumatized patients with a full stomach who require prolonged or painful interventions, properly conducted general anaesthesia using modern short-acting anaesthetic drugs and with monitoring and control of the airway, oxygenation, ventilation, and circulation is the safe option. Airway difficulties are dangerous in isolated environments and best managed in a familiar, well equipped and supported anaesthetic room with subsequent transfer of the anaesthetized and intubated patient for procedures outside the operating department. Hypothermia is common and may cause inadequate reversal of neuromuscular blockade. The anaesthetist is responsible for ensuring satisfactory standards of recovery and dependency of post-anaesthetic care that are appropriate to the needs of the patient.

Keywords: anaesthesia, non-technical skills, remote, standards