The Anaesthetic Period
Delegation of care Perioperative temperature management Consideration of principles of safe anaesthesia care provision is given elsewhere in the document as it pertains to professionalism, equipment and monitoring, medication, etc. The following are guidelines on issues not addressed elsewhere. Delegation of care The anaesthetist’s primary responsibility is to the patient currently under their ca
Perioperative temperature management
Consideration of principles of safe anaesthesia care provision is given elsewhere in the document as it pertains to professionalism, equipment and monitoring, medication, etc. The following are guidelines on issues not addressed elsewhere.
Delegation of care
The anaesthetist’s primary responsibility is to the patient currently under their care. The anaesthetist shall always remain with the patient throughout the conduct of all general anaesthesia, major regional anaesthesia, and procedural sedation and analgesia (PSA) until the patient is transferred to the care of personnel in an appropriate care unit.
If the attending anaesthetist leaves the operating room temporarily, care of the patient must be delegated to another anaesthesia provider. When the attending anaesthetist delegates care to an anaesthesia assistant (untrained physician, nurse, technician, etc.), the attending anaesthetist always remains responsible for the management of the patient under anaesthesia. Before delegating the patient’s care to an anaesthesia assistant, the anaesthetist must ensure that the patient’s condition is stable, and that the anaesthesia assistant is competent, experienced, and familiar with the operative procedure and the operating room environment and equipment. The attending anaesthetist must remain immediately available when care is delegated to an anaesthesia assistant.
An anaesthetist may briefly delegate routine care of a stable patient to a competent person who is not a trained anaesthesia provider only under the most exceptional circumstances, e.g., to provide lifesaving emergency care to another patient. That person’s only responsibility would be to monitor the patient during the anaesthetist’s absence and to keep the anaesthetist informed until returning to the theatre. In this situation, the anaesthetist remains responsible for the patient’s care and must inform the operating room team.
An intraoperative handover of care between two anaesthetists should be documented in the anaesthesia record and follow a structured protocol. It is unacceptable for one anaesthetist to simultaneously administer general anaesthesia, major regional anaesthesia, or moderate to deep procedural sedation (as classified in the SASA Guidelines for the safe use of procedural sedation and analgesia for diagnostic and therapeutic procedures in adults: 2020–2025 and the SASA paediatric guidelines for the safe use of procedural sedation and analgesia for diagnostic and therapeutic procedures in children: 2021–2026) on more than one patient.
Where only mild procedural sedation is administered, and provided an additional appropriately trained, qualified, and accredited individual, approved by the healthcare institution, is in constant attendance with each patient receiving care, it may be acceptable under these specific circumstances for one anaesthesia provider to supervise more than one patient.
In an obstetric unit, it is acceptable for one anaesthesia provider to supervise more than one patient receiving regional analgesia for labour, but only once the patient has been assessed to be stable and handed over to a qualified and experienced registered maternity unit nurse for monitoring.
The anaesthetist remains primarily responsible for extubation of the patient.
Perioperative temperature management
Monitoring patient core temperature is strongly recommended during cases of general and neuraxial regional anaesthesia lasting 30 min or longer.
In the absence of surgical or patient indications for intraoperative hypothermia, active patient warming systems, control of the operating room ambient temperature, and other methods, should be used to target a central core temperature of 36–37 °C.
Monitoring patient core temperature is strongly recommended during cases of general and neuraxial regional anaesthesia lasting 30 min or longer.
South African Society of Anaesthesiologists (SASA) Practice Guidelines_2022_Delegation of Care_Reviewed by: A de Goede and T Hlongwane_Perioperative Temperature Management_To be Reviewed in 2026