Intraoperative anaesthetic machine failure represents an immediate risk to patient safety, as well as risking long-term harm in the form of accidental awareness under general anaesthesia. Currently, there is no widely accepted consensus guidance for the management of such an event. Based upon institutional experiences of anaesthetic machine failure and the principles of delivering good-quality care under emergency scenarios, we devised a single-sheet guideline for management of this event. This guidance assigns clear roles in the management of the event, identifies the key priorities for immediate care, and makes provisions for ensuring ongoing high-quality care following the event. Discussion is given to the rationale for the key components, and the importance of involving the whole perioperative team in developing such guidance. Further discussion involves the crucial elements of local implementation, making sure that guidance is location and personnel specific. Key future steps in this important patient safety project are also discussed.