Some patients, for example those with restricted mobility, may require specific equipment such as hoists to position them. Preoperative planning should ensure that such equipment is available and should allow for the extra time and staff needed to position these patients safely.
Very frail patients may not benefit from some types of ophthalmic surgery, and a conservative approach should be considered.21
Dementia is a growing problem; it is estimated there will be 1.5 million people in the UK with dementia by 2040. Evidence suggests there is a benefit in performing early cataract surgery in these patients, maximising cognitive improvement and minimising post-operative cognitive dysfunction.21
The discipline of ophthalmic surgery encompasses the following areas: intraocular surgery, extraocular surgery, oculoplastic surgery, nasolacrimal surgery and orbital surgery. Ophthalmic surgery is undertaken in a wide variety of different settings, including multispecialty general hospitals, isolated units and large, single-specialty centres. All environments require appropriate staffing levels, skill mix and facilities. The ophthalmic anaesthetist has a key role in...
Mechanisms for the early recognition of patients requiring specialist postoperative input from geriatrician led services and/or critical care should be developed. These should include patients at risk of or presenting with delirium, multiple medical complications, functional decline or those requiring complex discharge planning.
There is a high prevalence of recognised and unrecognised cognitive impairment amongst older surgical patients. This has implications for shared decision making, the consent process and perioperative management. Older patients should have preoperative cognitive assessment using established screening or diagnostic tools.248
Each department of anaesthesia should have a lead anaesthetist for patients with cognitive impairment with sufficient time identified for the role in their job plan.248
