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Patients with severely restricted mobility pose additional problems when attempting to position for surgery. Time should be spent preoperatively with these patients explaining the surgical requirements, and assessing the patient's ability to lie flat before a final decision to operate is taken.

Additional resources may be necessary at the time of surgery, and may include additional personnel, hoists, or extra time allocation on the operating list.

Complex ophthalmic surgical cases often require specialised anaesthetic input. This may include patients having repeated ophthalmic procedures, long and difficult cases, and those potentially requiring specialist intravenous drug therapy, such as IV steroids, acetazolamide or mannitol. An anaesthetist of appropriate experience should have sole responsibility for operating lists containing such complex cases.

Patients requiring anaesthesia who are systemically unwell should be optimised as far as reasonably practicable beforehand.³² It is extremely rare for ophthalmic surgery to be so urgent that remedial measures cannot be taken. Arrangements for appropriate perioperative medical care should be made, with specialist input from other services as required.

Protocols should be in place for the transfer of patients from isolated units who become ill unexpectedly. They should be moved safely and rapidly to a facility which provides an appropriate higher level of care.¹²

Where necessary, these patients should be anaesthetised in an emergency theatre suite, taking specialist personnel and equipment to the patient, rather than vice versa.

When the specialist equipment cannot be moved, all necessary emergency equipment should be immediately available and transfer arrangements to a high dependency or intensive care setting should be in place

Owing to the risk of life threatening complications, sharp needle based blocks (e.g. peribulbar or retrobulbar block) should not be administered by non-medically qualified personnel.² Intravenous access should be established prior to performing sharp needle blocks and for any patient deemed to be high risk due to severe comorbidity.²

The Anaesthesia Associates (AAs) should work at all times within an anaesthesia team led by a consultant anaesthetist who has overall responsibility for anaesthesia care of the patient and whose name should be recorded in the individual patient’s medical notes.³

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