Search

All necessary anaesthetic equipment should be available. Devices and equipment should be suitable for the task for which they are used, and should conform to verified standards. Equipment should be maintained and serviced regularly.¹⁸

Anaesthetists should be trained in the use of, and be familiar with, all equipment they use regularly. The anaesthetist has a primary responsibility to check such equipment before use.¹⁹

Where lasers are in use for ophthalmic surgery, the correct safeguards must be in place.^20,21

Where possible, ophthalmic surgery should be postponed until after delivery. When this is not possible, guidelines on anaesthetising pregnant patients should be followed, e.g. use of left lateral tilt after 16 weeks’ gestation.⁷ Local anaesthesia, with or without anxiolytic sedation, is usually preferable to general anaesthesia.

Much of the ophthalmic surgical population is elderly and frail, and guidelines on perioperative care of elderly patients should be followed.¹

Services should be streamlined to make preassessment, surgery and postoperative care as simple and effective as possible. Travel and repeated hospital attendance may be especially difficult for these patients.¹

Special care should be taken to assess social circumstances when discharging elderly patients into the care of an equally frail and elderly spouse. Home support from family or social services may be needed; for instance to ensure that postoperative eye drops are administered in an appropriate and timely fashion. This should be identified at preassessment and arranged in advance.¹

A patient’s consent to participate in research projects should be obtained by those conducting the study and not by the anaesthetist providing care for the operation. Consent should be obtained on a separate signed document and approval should be sought from the anaesthetist who will be delivering the anaesthetic to the patient.^79,81

Older patients should be assessed for risk of postoperative cognitive dysfunction and preoperative interventions undertaken to reduce the incidence, severity and duration. Hospitals should ensure guidelines are available for the prevention and management of postoperative delirium and circulated preoperatively to the relevant admitting teams.³¹

Postoperative cognitive dysfunction is a particular concern and can disrupt otherwise stable home circumstances. The risk should be reduced as far as possible by minimising interventions and using local anaesthesia alone when feasible.¹