Summary Postoperative sore throat has a reported incidence of up to 62% following general anaesthesia. In adults undergoing tracheal intubation, female sex, younger age, pre‐existing lung disease, prolonged duration of anaesthesia and the presence of a blood‐stained tracheal tube on extubation are associated with the greatest risk. Tracheal intubation without neuromuscular blockade, use of double‐lumen tubes, as well as high tracheal tube cuff pressures may also increase the risk of postoperative sore throat. The expertise of the anaesthetist performing tracheal intubation appears to have no influence on the incidence in adults, although it may in children. In adults, the i‐gel™ supraglottic airway device results in a lower incidence of postoperative sore throat. Cuffed supraglottic airway devices should be inflated sufficiently to obtain an adequate seal and intracuff pressure should be monitored. Children with respiratory tract disease are at increased risk. The use of supraglottic airway devices, oral, rather than nasal, tracheal intubation and cuffed, rather than uncuffed, tracheal tubes have benefit in reducing the incidence of postoperative sore throat in children. Limiting both tracheal tube and supraglottic airway device cuff pressure may also reduce the incidence.

The use of cell salvage is recommended when it can be expected to reduce the likelihood of allogeneic (donor) red cell transfusion and/or severe postoperative anaemia. We support and encourage a continued increase in the appropriate use of peri-operative cell salvage and we recommend that it should be available for immediate use 24 h a day in any hospital undertaking surgery where blood loss is a recognised potential complication (other than minor/day case procedures).

Summary Guidelines are presented for the organisational and clinical management of anaesthesia for day‐case surgery in adults and children. The advice presented is based on previously published recommendations, clinical studies and expert opinion.

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SummaryHuman factors is an evidence‐based scientific discipline used in safety critical industries to improve safety and worker well‐being. The implementation of human factors strategies in anaesthesia has the potential to reduce the reliance on exceptional personal and team performance to provide safe and high‐quality patient care. To encourage the adoption of human factors science in anaesthesia, the Difficult Airway Society and the Association of Anaesthetists established a Working Party, including anaesthetists and operating theatre team members with human factors expertise and/or interest, plus a human factors scientist, an industrial psychologist and an experimental psychologist/implementation scientist. A three‐stage Delphi process was used to formulate a set of 12 recommendations: these are described using a ‘hierarchy of controls’ model and classified into design, barriers, mitigations and education and training strategies. Although most anaesthetic knowledge of human factors concerns non‐technical skills, such as teamwork and communication, human factors is a broad‐based scientific discipline with many other additional aspects that are just as important. Indeed, the human factors strategies most likely to have the greatest impact are those related to the design of safe working environments, equipment and systems. While our recommendations are primarily provided for anaesthetists and the teams they work with, there are likely to be lessons for others working in healthcare beyond the speciality of anaesthesia.

Summary There are approximately 8.5 million Jehovah's Witnesses and around 150,000 live in Great Britain and Ireland. Based on their beliefs and core values, Jehovah's Witnesses refuse blood component transfusion (including red cells, plasma and platelets). They regard non‐consensual transfusion as a physical violation. Consent to treatment is at the heart of this guideline. Refusal of treatment by an adult with capacity is lawful. The reasons why a patient might refuse transfusion and the implications are examined. The processes and products that are deemed acceptable or unacceptable to Jehovah's Witnesses are described. When a team is faced with a patient who refuses transfusion, a thorough review of the clinical situation is advocated and all options for treatment should be explored. After discussion, a plan should then be made that is acceptable to the patient and appropriate consent obtained. When agreement cannot be reached between the doctor and the patient, referral for a second opinion should be considered. When the patient is a child, the same strategy should be used but on occasion the clinical team may have to obtain legal help.

Healthcare relies on high levels of human performance, as described by the `human as the hero´concept. However, human performance varies and is recognised to fall in high-pressure situations, meaning that it is not a reliable method of ensuring safety. Other safety-critical industries embed human factors principles into all aspects of their organisations to improve safety and reduce reliance on exceptional human performance; there is potential to do the same in anaesthesia. Human factors is a broad-based scientific discipline which aims to make it as easy as possible for workers to do things correctly. The human factors strategies most likely to be effective are those which `design out´the chance of an error or adverse event occurring. When errors or adverse events do happen, barriers are in place to trap them and reduce the risk of progression to patient and/or worker harm. If errors or adverse events are not trapped by these barriers, mitigations are in place to minimise the consequences. Non-technical skills form an important part of human factors barriers and mitigation strategies and include: situation awareness; decision-making; task management; and team working. Human factors principles are not a substitute for proper investment and appropriate staffing levels. Although applying human factors science has the potential to save money in the long term, its proper implementation may require investment before reward can be reaped. This narrative review describes what is known about human factors in anaesthesia to date.