<p>Non-Operating Room Anesthesia: Patient Selection and Special Considerations</p>

Abstract

Non-operating room anesthesia (NORA) represents a growing field of medicine with an increasing trend in the number of cases performed over the previous decade. As a result, anesthesia providers will need to enhance their familiarity with the resources, personnel, and environment outside of the operating room. Anesthesia delivery in NORA settings should be held with the same high-quality standards as that within the operating room. This review looks at special considerations in patient selection and the preoperative, intraoperative, and postoperative periods. In addition, there is a discussion on the unique aspects of specific NORA areas and the considerations that come with them.

Morbidity, mortality, and systems safety in non-operating room anaesthesia: a narrative review

“…In general, NORA spaces were not designed to accommodate anaesthesia providers. Environmental concerns were commonly noted and included inadequate lighting, 1,3,4,14,17 loud noise levels, 3,19,31 restricted patient access, 2,4,14,19,27 lack of electrical outlets, 14,16,26,37 and cramped workspaces. 1,16,21,32 In the MRI suite, patients are not all the way visible to the anaesthesia provider, and procedures, such as colonoscopy, esophagogastroduodenoscopy, and endoscopic retrograde cholangiopancreatography, require dimmed lights so the gastroenterologist can see the screen and perform the procedure, contributing to inadequate ambient lighting.…”

“…1,3,16,19,21e23,29,31 Equipment used for the NORA procedures interfered with anaesthesia administration by hindering sight lines, visibility, and patient access. 3,29 Taskrelated challenges include lack of rigorous preoperative check in procedures, insufficient time to conduct preoperative assessment, 21,23,37 and lack of access to anaesthesia or pharmacy support staff. 16,17,22,26,31,37,38 Person-related factors included lack of team familiarity, poor communication, 16,17,23,30,32 and limited knowledge of anaesthesia administration or emergency procedures.…”

“…3,29 Taskrelated challenges include lack of rigorous preoperative check in procedures, insufficient time to conduct preoperative assessment, 21,23,37 and lack of access to anaesthesia or pharmacy support staff. 16,17,22,26,31,37,38 Person-related factors included lack of team familiarity, poor communication, 16,17,23,30,32 and limited knowledge of anaesthesia administration or emergency procedures. 1,19,22,23,30,38 Organisational challenges noted included lack of essential equipment, 14,16,22,27,30 such as PACUs not equipped to care for a patient with a left ventricle assist device.…”

“…Other organisation challenges included lack of backup medication, 3,4,23 nonstandardised workstation setups, 1,26,32,34,36 and inexperienced postoperative care team. 17,26,37,38…”

Training in pediatric anesthesia in Japan: how should we come along?

“…Subsequently, there are rising trends of minimally invasive surgeries including robotic surgery [18] and sedation or anesthesia outside the operating room [19][20][21]. Although these practices are not different in pediatric and adult patients, they may offer unique challenges, requiring the anesthesiologists' scrupulous knowledge and comprehension on the associated anatomical and physiological considerations in pediatric patients [22].…”