Non-operating Room Anesthesia: Is It Worth the Risk?
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PATIENT SAFETY IN ANESTHESIA (SJ BRULL, SECTION EDITOR)
Non-operating Room Anesthesia: Is It Worth the Risk? Bruce J. Leone 1,2 Accepted: 8 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Non-operating room anesthesia (NORA) has continued to grow. This review provides recent views on the subject and an overview of specific concerns in specialized NORA applications. Recent Findings Recent literature has reviewed the data from national databases and found no differences in the outcomes of patients undergoing NORA for procedural interventions as opposed to those patients undergoing surgical procedures. Specific areas may have their own challenges and types of patients; however, creation of a system for evaluating, anesthetizing, and recovering these patient from anesthesia results in significant patient benefit. Summary NORA has been shown to be safe in recent reviews of national data. The future will most likely involve increasing use of NORA; thus, involvement of anesthesiology departments in the planning and building of new spaces for interventions will augment the benefit and decrease the risk of future patient care. Keywords Remote anesthesia . Non-operating room anesthesia . Gastroenterology . Interventional radiology . Anesthesia risk
Introduction Anesthesia in remote locations, also known as non-operating room anesthesia (NORA), has become more prevalent in today’s hospitals [1••]. This may task the anesthesiologist with performing sedation or general anesthesia in areas not originally designed for administering anesthesia to patients who may not be suitable for surgical procedures. The expertise of the anesthesiologist to provide medical management and adequate amnesia and analgesia to patients outside of the operating room enables interventions that could not be performed safely without specific equipment and a comfortable patient. However, there are risks that are compounded with a NORA procedure. Firstly, the anesthesia team will be in a procedural area that was likely not designed for the additional presence of an anesthesia provider. Thus, the work area reserved for anesthesia providers may be cramped or insufficient for the anesthesia equipment to be in a traditional arrangement used in This article is part of the Topical Collection on Patient Safety in Anesthesia
operating rooms. Secondly, patients may present for emergent procedures requiring interventions without an adequate preoperative assessment. Lastly, the physical separation of the NORA location from operating rooms and, in many cases, the majority of the anesthesia supplies and personnel may make an emergent situation (e.g., difficult or lost airway) riskier due to a lack of appropriate equipment or help [2•]. NORA is a constantly evolving practice, as interventionalists and proceduralists, similar to surgical specialties, continue to innovate. Certainly, surgical intervention has been propelled and spurred further by technological advancements and refinements, such as the develo
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