Non-operating room anesthesia (NORA) - NYSORA

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Non-operating room anesthesia (NORA)

Learning objectives

  • Consider the limitations and challenges of non-operating room anesthesia
  • Describe the anesthetic considerations for specific non-operating room anesthesia procedures

Background

  • Non-operating room anesthesia (NORA) refers to all anesthetic procedures performed outside of the operating room
  • NORA is a growing field in healthcare
  • Unfamiliarity with the environment can be a challenge

Considerations

  • Limitations of the room
  • Equipment may be lacking
  • Unfamiliar environment
  • Staff may be unfamiliar with anesthetic procedures
  • Exposure to radiation
  • NORA sites have a greater proportion of ASA status III-V patients
  • Anesthetic procedures, monitoring, and analgesia should be held to the same standards as in the operating room
  • Potential for ad hoc requests, scheduling inconsistencies, poor communication, and less patience

Common NORA procedures

non-operating room anesthesia, esophagogastroduodenoscopy, endoscopic retrograde cholangiopancreatography, endoscope, prone, lidocaine, benzocaine, propofol, midazolam, interventional radiology, phrenic nerve block, for CT-guided pulmonary biopsies, paravertebral block for biliary drainage, Interventional cardiology, percutaneous coronary intervention, percutaneous transcatheter aortic valve replacement, transcatheter mitral valve repair, defibrillator, Interventional pulmonology, endobronchial ultrasound, transbronchial needle aspiration, balloon bronchoplasty, airway stents, bronchoalveolar lavages, Magnetic resonance imaging, claustrophobic, phonophobic, IVF, oocytes, paracervical, epidural, spinal, general anesthesia, IV sedation

Suggested reading

  • Wong T, Georgiadis PL, Urman RD, Tsai MH. Non-Operating Room Anesthesia: Patient Selection and Special Considerations. Local Reg Anesth. 2020;13:1-9. Published 2020 Jan 8. doi:10.2147/LRA.S181458
  • Chung M, Vazquez R.  Non-Operating Room Anesthesia. In: Gropper MA, editor. Miller’s Anesthesia, Ninth Edition, 2020.  Elsevier, Philadelphia.  p. 2284-2312.

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