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
  • Canular 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

  • Stabismus 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