2016
DOI: 10.1097/aco.0000000000000344
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Practical considerations in the development of a nonoperating room anesthesia practice

Abstract: Involvement of anesthesia providers at the development stage and an understanding of the administrative and clinical challenges are essential elements in the building of a NORA practice.

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Cited by 10 publications
(9 citation statements)
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“…These tasks have been successfully performed under GA without OTI (failure rate: 7%). Many authors speak of sedation or deep sedation when the patient is breathing spontaneously and of GA when an endotracheal tube secures the airway; in our opinion, considering the depth of anesthesia necessary to perform advanced therapeutic endoscopies, we can eagerly talk of GA with spontaneous breathing and without endotracheal tube because it is the level of sedation itself that makes the difference between deep sedation and GA.[ 4 5 11 ] We consider GA being the only acceptable choice for the procedure according to the ASA definition,[ 2 ] because it realizes the necessary depth of anesthesia and keeps the patient motionless, thus permitting the precise and delicate endoscopic maneuvers. The challenge is to achieve a GA level in a spontaneously breathing prone patient where an endoscope de facto prevents manual ventilation, nevertheless realizing the optimal conditions for a safe upper GI procedure.…”
Section: Discussionmentioning
confidence: 99%
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“…These tasks have been successfully performed under GA without OTI (failure rate: 7%). Many authors speak of sedation or deep sedation when the patient is breathing spontaneously and of GA when an endotracheal tube secures the airway; in our opinion, considering the depth of anesthesia necessary to perform advanced therapeutic endoscopies, we can eagerly talk of GA with spontaneous breathing and without endotracheal tube because it is the level of sedation itself that makes the difference between deep sedation and GA.[ 4 5 11 ] We consider GA being the only acceptable choice for the procedure according to the ASA definition,[ 2 ] because it realizes the necessary depth of anesthesia and keeps the patient motionless, thus permitting the precise and delicate endoscopic maneuvers. The challenge is to achieve a GA level in a spontaneously breathing prone patient where an endoscope de facto prevents manual ventilation, nevertheless realizing the optimal conditions for a safe upper GI procedure.…”
Section: Discussionmentioning
confidence: 99%
“…The main challenge in this setting is to counteract the most common adverse event, i.e., respiratory failure, often due to over-sedation, according to Metzer[ 10 ] and Goudra. [ 5 ] They reported that the proportion of respiratory adverse events in NORA, according to the number of claims, was double compared to the incidence of similar events in OR (44 vs. 20%; P = 0.001). [ 5 10 ] Again, most of such respiratory events were due to desaturation following inadequate ventilation and oxygenation, which apparently have a seven times higher incidence in NORA than in OR (21% vs.…”
Section: Discussionmentioning
confidence: 99%
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