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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.

Patients exhibit extremely wide variation in response to drugs used for sedation. Coupled with this uncertain pharmacodynamic response, patient access during ophthalmic surgery is often very limited and airway manipulation may be difficult should a state of deep sedation occur. In view of these safety concerns, administration of intravenous sedation during ophthalmic surgery should only be undertaken by an anaesthetist...

Patients do not need to be starved when sedative drugs are used in low doses to produce simple anxiolysis.²⁷ Patients should be starved when deeper planes of sedation are anticipated or sedative infusions employed.^27,33

If a hospital has the capacity to provide training in ophthalmic anaesthesia, anaesthetic trainees should be given the opportunity to gain exposure in this unit of training.³⁴

Anaesthetic trainees should be trained in order to obtain the learning outcomes as stipulated in the RCoA curriculum for ophthalmic anaesthesia.³⁵

Structured training in regional orbital blocks should be provided to all inexperienced practitioners who wish to learn any of these techniques. This should include an understanding of the relevant ophthalmic anatomy, physiology and pharmacology, and the prevention and management of complications.² Where possible, trainees should be encouraged to undertake ‘wetlab’ training or use simulators to improve practical skills.^36,37

Intermediate level training as set out in the RCoA curriculum³⁵  should be an essential criterion and higher level training a desirable criterion in the person specification for a consultant appointment with ophthalmic anaesthetic sessions in the job plan.

All anaesthetists working in ophthalmic services should have access to continuing educational and professional development facilities for advancing their knowledge and practical skills associated with ophthalmic anaesthesia.³⁸