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Sharp needle based blocks (e.g. peribulbar or retrobulbar block) should only be administered by medically qualified personnel, because of the increased risks of life-threatening complications.2 Intravenous access should be established prior to performing sharp needle blocks and also for any patient deemed to be at high risk due to severe comorbidity.²

All modes of ophthalmic local anaesthesia may result in complications.²²Practitioners should be fully aware of these risks and should ensure that they know how to avoid and recognise complications. They should also be immediately available and able to safely and effectively manage problems when they do occur.

Patients exhibit extremely wide variation in response to drugs used for sedation. It is difficult to and undesirable to have to manipulate the airway of an unpredictably over-sedated patient during surgery, and so administration of intravenous sedation during ophthalmic surgery should only be undertaken by an anaesthetist whose sole responsibility for the duration of the surgery is to that patient.²

Patients do not need to be starved when sedative drugs are used in low doses to produce simple anxiolysis. Patients should follow fasting guidelines as for general anaesthesia when deeper planes of sedation are anticipated or sedative infusions employed.^_27,37,38

Hospitals should use the training opportunities available in ophthalmic anaesthesia to facilitate anaesthetists in training's acquisition of the learning outcomes of the RCoA 2021 Curriculum.³⁹

Anaesthetists in training may be given the opportunity to train in ophthalmic Anaesthesia as a special interest area of the RCoA 2021 Curriculum if the hospital caseload and capacity for training meet the requirements for this special interest area.^39,40

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.^41,42,43

Intermediate level training as set out in the RCoA 2010 Curriculum⁴¹should be an essential criterion and higher level training a desirable criterion in the person specification for a consultant or autonomously practising anaesthetist with ophthalmic anaesthetic sessions in the job plan. For candidates who are trained on the RCoA 2021 Curriculum, the special interest area in ophthalmic anaesthesia...

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.⁴⁴

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.⁴⁵