Where paediatric ophthalmic surgery is performed, appropriate paediatric anaesthetic equipment and monitoring should be available. This should be checked regularly.15
Adult life support (ALS) protocols should be readily accessible,16 and the ALS algorithms may be displayed. Paediatric life support protocols should be available and accessible where paediatric surgery is performed.
All necessary anaesthetic equipment should be available. Devices and equipment should be suitable for the task for which they are used, and should conform to verified standards. Equipment should be maintained and serviced regularly.18
Anaesthetists should be trained in the use of, and be familiar with, all equipment they use regularly. The anaesthetist has a primary responsibility to check such equipment before use.19
Where possible, ophthalmic surgery should be postponed until after delivery. When this is not possible, guidelines on anaesthetising pregnant patients should be followed, e.g. use of left lateral tilt after 16 weeks’ gestation.7 Local anaesthesia, with or without anxiolytic sedation, is usually preferable to general anaesthesia.
Much of the ophthalmic surgical population is elderly and frail, and guidelines on perioperative care of elderly patients should be followed.1
Services should be streamlined to make preassessment, surgery and postoperative care as simple and effective as possible. Travel and repeated hospital attendance may be especially difficult for these patients.1
Special care should be taken to assess social circumstances when discharging elderly patients into the care of an equally frail and elderly spouse. Home support from family or social services may be needed; for instance to ensure that postoperative eye drops are administered in an appropriate and timely fashion. This should be identified at preassessment and arranged in advance.1
