CCT in Anaesthetics - Intermediate Level Training

Published: 05/09/2019

Optional Units: Ophthalmic

This is one of the ‘optional’ Intermediate level units of training; whilst trainees are not expected to gain practical experience in this area of practice, they should obtain the competencies identified in the knowledge section as this forms part of the Final FRCA curriculum and therefore can be assessed

Learning outcomes:

To gain knowledge, skills and experience of the perioperative anaesthetic care of patients undergoing ophthalmic surgery
To understand the rationale behind the choice of local or general anaesthesia for common ophthalmic procedures

Core clinical learning outcomes:

Deliver safe perioperative anaesthetic care to adults and children requiring routine ophthalmic surgery under direct supervision, and emergency anaesthesia for ASA 1 and 2 patients requiring minor/ intermediate ophthalmic surgery under distant supervision
Demonstrates the ability to provide local anaesthesia for eye surgery with competence in one technique

NB: All competencies annotated with the letter ‘E’ can be examined in any of the components of the Final examination identified in the FRCA examination blueprint section.

Knowledge

Competence	Description	Assessment Methods	GMP
OP_IK_01	Discusses the preoperative assessment of ophthalmic patients with particular reference to associated co-morbidities and how the care of high risk patients requiring ophthalmic surgery may be optimised	A,C,E	1,2,3,4
OP_IK_02	Recognises that a relatively large proportion of patients requiring ophthalmic surgery are elderly and understands their particular needs including, but not exclusively, the effects of physiological changes associated with ageing and altered pharmacological responses	A,C,E	1,2
OP_IK_03	Recalls/discusses the choice of local or general anaesthetic techniques in relation to the patient and surgery including their advantages, disadvantages and indications with particular reference to some or all of the following: Cataract surgery Strabismus surgery Glaucoma surgery Vitreoretinal surgery Oculoplastic surgery	A,C,E	1
OP_IK_04	Recalls/describes the oculocardiac reflex, its treatment and prevention	A,C,E	1
OP_IK_05	Recalls/describes the action of anaesthetic drugs on the eye	A,C,E	1
OP_IK_06	Recalls the physiological mechanisms which control intraocular pressure	A,C,E	1
OP_IK_07	Recalls/discusses the drugs which may alter intraocular pressure	A,C,E	1
OP_IK_08	Knowledge of precautions required for revision surgery in patients who have had a previous injection of intraocular gas		1
OP_IK_09	Recalls/discusses the choice of techniques of anaesthesia for patients with penetrating eye injury	A,C,E	1,2
OP_IK_10	Describes the operating conditions required for successful outcomes in ophthalmic surgery and how these can be achieved	A,C,E	1
OP_IK_11	Recalls/discusses the special requirements of children undergoing ophthalmic surgery	A,C,E	1,2
OP_IK_12	Describes the advantages and disadvantages of sedation techniques for ophthalmic procedures	A,C,E	1,2
OP_IK_13	Outlines the safety precautions required during the use of lasers in ophthalmic surgery	A,C,E	1,2
OP_IK_14	Recalls relevant applied anatomy required for insertion of local anaesthetic blocks for ophthalmic surgery [Cross reference applied basic sciences]	A,C,E	1
OP_IK_15	Recalls/describes the techniques of local anaesthesia available for ophthalmic surgery including their advantages, disadvantages and indications with particular reference to: Topical anaesthesia: local anaesthesia drops Superficial injection anaesthesia: subconjunctival block Needle blocks: extraconal [peribulbar] and intraconal [retrobulbar] injections Cannula blocks: sub-tenon’s anaesthesia	A,C,E	1
OP_IK_16	Recalls/describes the risks associated with needle blocks	A,C,E	1,2
OP_IK_17	Awareness of the national guidelines regarding local anaesthesia for intraocular surgery	A,C,E	1
OP_IK_18	Awareness of specific risk of wrong-site surgery when operating on paired organs such as the eyes		1,2
OP_IK_19	Outlines the specific factors in the postoperative care of patients who have had ophthalmic surgery	A,C,E	1

Skills

Competence	Description	Assessment Methods	GMP
OP_IS_01	Demonstrates effective preoperative assessment and preparation of patients for ophthalmic procedures	A,M	1,2,3,4
OP_IS_02	Demonstrates good communication skills, with particular reference to the elderly, when explaining the risks and benefits of general and local anaesthetic techniques for eye surgery	A,M	1,2,3,4
OP_IS_03	Demonstrates the provision of safe perioperative anaesthetic care in patients with significant co-morbidities and with consideration of the specific requirements for ophthalmic surgical procedures including: • Cataract surgery Strabismus surgery Glaucoma surgery Vitreoretinal surgery Oculoplastic surgery	A,C,D,M	1
OP_IS_04	Demonstrates appropriate choice of airway maintenance techniques for general anaesthesia for ophthalmic procedures	A,C,D	1,2
OP_IS_05	Demonstrates techniques for control of perioperative intraocular pressure	A,C,D	1
OP_IS_06	Demonstrates techniques for the safe use of lasers in ophthalmic surgery	A,C,D	1
OP_IS_07	Demonstrates ability to use topical eye preparations, including awareness of possible effects and interactions	A,C,D	1
OP_IS_08	Demonstrates provision of local anaesthesia for eye surgery obtaining competence in at least one block	C,D	1