Introduction

Diagnostic and therapeutic interventions outside the operating room (OR) have been happening for the past many decades. In the past, the patients encountered were simple, with almost no comorbidities and therefore did not require anesthesia. The increasing number of complex patients compounded by advanced procedures mandates the presence of and care by anesthetists to make procedures comfortable for the patients and improve patient outcomes.

The infrastructure, available human resources, along with their technical skills, are usually less familiar to anesthetists, unlike the OR.

“Administration of sedation/anesthesia to patients undergoing painful or uncomfortable procedures at off-site locations is referred to as nonoperating room anesthesia (NORA).”

Challenges Unique to NORA

Performing procedures outside of the OR creates a new set of challenges for anesth­esiologists. The challenges are as follows:

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  Patients scheduled for NORA suites are sometimes more complex and poorly optimized compared with the general OR population.

  
  
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  NORA suites are designed to target the needs of the procedural operator, with less focus on the needs of anesthesiologists.

  
  
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  The NORA suites are usually unfamiliar and crowded.

  
  
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  Limited and inadequate access to patients.

  
  
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  First-time visitors sometimes find it diffi­cult to reach NORA suites due to their locations in deep trenches of the hospital.

  
  
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  There is often limited access to resources such as space, monitors, anesthesia equip­ment, and medications.

  
  
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  At times, anesthesia equipment is lacking in the NORA suites, and there may be delayed availability of additional help in case of need.

  
  
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  The pressure to perform a rapid evaluation of patients with limited information and the urgent nature of the procedures may make anesthetic management challenging and risky.

  
  
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  Anesthesiologists may be expected to recover patients in busy recovery suites without dedicated extended postopera­tive monitoring capabilities and with staff who may not routinely recover patients from general anesthetics.

All of these difficulties create a unique challenge that each anesthesiologist faces when delivering anesthetics in these locations. Some of the NORA sites include the following:

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  Radiology.

  
  
  
  
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    Interventional.

    
    
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    MRI (all the equipment used in the MRI suite should be MRI-compatible. The types of equipment used in MRI are made up of aluminium).

    
    
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    CT scan.

  
  
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  Gastroenterology endoscopies.

  
  
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  Cardiac interventions:

  
  
  
  
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    Catheterization.

    
    
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    Interventional cardiology.

    
    
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    Transesophageal echocardiography.

  
  
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  Lithotripsy.

  
  
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  Electroconvulsive therapy sites.

  
  
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  Obstetric labor and delivery.

  
  
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  Ambulatory procedure rooms.