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Appropriate staffing levels and skill mix should be provided in all units: multispecialty general hospitals, isolated units and large single-specialty centres delivering ophthalmic anaesthesia. For most operating sessions this should include surgeon, anaesthetist, two theatre-trained scrub practitioners, one trained nurse or operating department practitioner to assist with local anaesthesia/patient monitoring and one theatre support worker/runner.^2,3 

Dedicated, skilled assistance for the anaesthetist should be available in every situation where anaesthesia or sedation is employed.^4,5

Each department or facility that provides ophthalmic anaesthesia services should have a clinical lead (see Glossary) with nominated responsibility for ophthalmic anaesthesia.²

There should be an identified group of senior anaesthetists who manage and deliver a comprehensive ophthalmic anaesthesia service, including the use of orbital regional anaesthetic techniques.²

Many ophthalmic patients have significant comorbidities that may require optimisation and coordination prior to surgery. There should be a lead anaesthetist (with an appropriate number of programmed activities in their job plan and appropriate secretarial support) for preoperative assessment, who works closely with an appropriately trained preoperative assessment team.^6,7 

All ophthalmic surgery should be carried out in a facility that is appropriately staffed and equipped for resuscitation.^2,8

Staff should be trained in basic life support and there should be immediate access to a medical team with advanced life support capabilities.⁸

In isolated units where no anaesthetist or medical emergency team is immediately available, there should be at least one person with advanced life-support training or equivalent.^2,9 A clear and agreed pathway should be in place for isolated units to enable the patient to receive appropriate advanced medical care, including intensive care, in the event of it...

If no anaesthetist is present in theatre, an appropriately trained anaesthetic nurse, ophthalmic theatre nurse or operating department practitioner should be present to monitor the patient during establishment of local anaesthesia and throughout the operative procedure. This should be their sole responsibility.²

Wherever possible, anaesthesia in remote ophthalmic surgical sites should be delivered by an appropriately experienced consultant or autonomously practising anaesthetist. Where a trainee or non-consultant grade is required to provide anaesthetic services at a remote site, the recommendations of the Royal College of Anaesthetists should be followed.¹⁰