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A patient’s consent to participate in research projects should be obtained by those conducting the study and not by the anaesthetist providing care for the operation. Consent should be obtained on a separate signed document and approval should be sought from the anaesthetist who will be delivering the anaesthetic to the patient.79,81
Older patients should be assessed for risk of postoperative cognitive dysfunction and preoperative interventions undertaken to reduce the incidence, severity and duration. Hospitals should ensure guidelines are available for the prevention and management of postoperative delirium and circulated preoperatively to the relevant admitting teams.31
Postoperative cognitive dysfunction is a particular concern and can disrupt otherwise stable home circumstances. The risk should be reduced as far as possible by minimising interventions and using local anaesthesia alone when feasible.1
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
