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Patients exhibit extremely wide variation in response to drugs used for sedation. Coupled with this uncertain pharmacodynamic response, patient access during ophthalmic surgery is often very limited and airway manipulation may be difficult should a state of deep sedation occur. In view of these safety concerns, administration of intravenous sedation during ophthalmic surgery should only be undertaken by an anaesthetist...
Patients do not need to be starved when sedative drugs are used in low doses to produce simple anxiolysis.27 Patients should be starved when deeper planes of sedation are anticipated or sedative infusions employed.27,33
If a hospital has the capacity to provide training in ophthalmic anaesthesia, anaesthetic trainees should be given the opportunity to gain exposure in this unit of training.34
Anaesthetic trainees should be trained in order to obtain the learning outcomes as stipulated in the RCoA curriculum for ophthalmic anaesthesia.35
Structured training in regional orbital blocks should be provided to all inexperienced practitioners who wish to learn any of these techniques. This should include an understanding of the relevant ophthalmic anatomy, physiology and pharmacology, and the prevention and management of complications.2 Where possible, trainees should be encouraged to undertake ‘wetlab’ training or use simulators to improve practical skills.36,37
Intermediate level training as set out in the RCoA curriculum35 should be an essential criterion and higher level training a desirable criterion in the person specification for a consultant appointment with ophthalmic anaesthetic sessions in the job plan.
All anaesthetists working in ophthalmic services should have access to continuing educational and professional development facilities for advancing their knowledge and practical skills associated with ophthalmic anaesthesia.38
All staff should have access to adequate time, funding and facilities to undertake and update training that is relevant to their clinical practice, including resuscitation training.39
National safety standards for invasive procedures (NatSSIPs) should be adapted for local use as local safety standards for invasive procedures.39 The WHO process, for example, could be adapted to incorporate intraocular lens selection to help prevent ‘wrong lens’ errors.41
The consultant anaesthetist should be easily contactable, and should be available to attend within two minutes of being requested by the AAs.3
