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The majority of ophthalmic surgery is done as day case procedures under local anaesthesia.²² Preoperative assessment should identify those patients who are not suitable for this approach and who might require general anaesthesia or intravenous sedation.^2,23

Patients who require anaesthesia or intravenous sedation should undergo preoperative anaesthetic assessment.⁷

Where ophthalmic surgery is performed as a day case procedure, the facilities should conform to best practice guidance. Day surgery operating theatres should meet the same standards as inpatient operating theatres.^24,25,26 Room should be available for patients to be seen in private by the anaesthetist and surgeon on the day of surgery.² A supervised...

In units where ophthalmic surgery is performed, including locations that may be isolated from main theatre services, facilities provided should allow for the safe conduct of anaesthesia and sedation. This would include monitoring equipment, oxygen, availability of opioid and benzodiazepine antagonist drugs, a recovery area, and drugs and equipment to deal with emergencies such as cardiac arrest, anaphylaxis and local...

All areas in which ophthalmic anaesthesia is performed should have a reliable supply of the medicines required to deliver safe anaesthesia and sedation. Storage arrangements should be such that there is prompt access to them if clinically required, maintains integrity of the medicines and compliance with safe and secure storage of medicines regulations is ensured.³⁰ In addition, anaesthetists and...

Facilities should be available, or transfer arrangements should be in place, to allow for the overnight stay of patients who cannot be treated as day cases or who require unanticipated admission.

Optimal patient positioning is critical to the safe conduct of ophthalmic surgery and for patient comfort. Adjustable trolleys/operating tables which permit correct positioning should be available.

Some patients, for example those with restricted mobility, may require specific equipment such as hoists to position them. Preoperative planning should ensure that such equipment is available, and allow for the extra time and staff needed to position these patients safely.

In areas where ophthalmic surgery is performed, resuscitation equipment and drugs should be immediately available in case of cardiorespiratory arrest. These should include a standardised resuscitation trolley and defibrillator. The manufacturer’s instructions must be followed regarding use, storage, servicing and expiry of equipment and drugs.⁸

Where risks of adverse patient outcome with surgery are identified as being high, the preoperative assessment consultation facilitates shared patient discussion, which may result in a well-informed individual opting for non-surgical management. Under such circumstances the decision-making process should be endorsed through close collaborative discussion with surgical colleagues - ideally a preoperative MDT meeting.