Non-operating Room Anaesthesia Research Articles

Respiratory monitoring of nonintubated patients in nonoperating room settings: old and new technologies.

Postoperative mortality in the 30 days after surgery remains disturbingly high. Inadequate, intermittent and incomplete monitoring of vital signs in the nonoperating room environment is common practice. The rise of nonoperating room anaesthesia and sedation outside the operating room has highlighted the need to develop new and robust methods of portable continuous respiratory monitoring. This review provides a summary of old and new technologies in this environment. Technical advances have made possible the utilization of established monitoring to extrapolate respiratory rate, the increased availability and user friendliness of side stream capnography and the advent of other innovative systems. The use of aggregate signals wherein different modalities compensate for individual shortcomings seem to provide a reliable and artefact-free system. Respiratory monitoring is required in several situations and patient categories outside the operating room. The chosen modality must be able to detect respiratory compromise in a timely and accurate manner. Combing several modalities in a nonobtrusive, nontethered system and having an integrated output seems to give a reliable and responsive signal.

ANAESTHESIA FOR REMOTE LOCATIONS

Non-operating room anaesthesia (NORA) describes anaesthesia provided outside a traditional operating room (OR). Due to technological advancements, increasing requirement is there for providing anaesthesia beyond operating room, outside of safe zones for anesthetist. It comes with lot of challenges like lack of team familiarity, limited preoperative evaluation, new locations, inadequate monitoring devices and restricted access to patients. Anaesthesia at remote locations require extreme vigilance, more expertise, knowledge about procedures.

The Impact of the Pandemic on Acute Ischaemic Stroke Endovascular Treatment from a Multidisciplinary Perspective: A Nonsystematic Review.

Background: At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, reduced admissions for cerebrovascular events were identified, but acute ischaemic stroke (AIS) has remained one of the leading causes of death and disability for many years. The aim of this article is to review current literature data for multidisciplinary team (MDT) coordination, rational management of resources and facilities, ensuring timely medical care for large vessel occlusion (LVO) AIS patients requiring endovascular treatment during the pandemic. Methods: A detailed literature search was performed in Google Scholar and PubMed databases using these keywords and their combinations: acute ischaemic stroke, emergency, anaesthesia, airway management, mechanical thrombectomy, endovascular treatment, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), COVID-19. Published studies and guidelines from inception to April 2021 were screened. The following nonsystematic review is based on a comprehensive literature search of available data, wherein 59 were chosen for detailed analysis. Results: The pandemic has an impact on every aspect of AIS care, including prethrombectomy, intraprocedural and post-thrombectomy issues. Main challenges include institutional preparedness, increased number of AIS patients with multiorgan involvement, different work coordination principles and considerations about preferred anaesthetic technique. Care of these patients is led by MDT and nonoperating room anaesthesia (NORA) principles are applied. Conclusions: Adequate management of AIS patients requiring mechanical thrombectomy during the pandemic is of paramount importance to maximise the benefit of the endovascular procedure. MDT work and familiarity with NORA principles decrease the negative impact of the disease on the clinical outcomes for AIS patients.

Non-operating room anaesthesia for a child with Beckwith Wiedemann syndrome with a history of congenital laryngomalacia.

Non-operating room anaesthesia for a child with Beckwith Wiedemann syndrome with a history of congenital laryngomalacia.

Anaesthesia for minimally invasive cardiac procedures in the catheterization lab.

The share of cardiac procedures performed in settings involving nonoperating room anaesthesia (NORA) continues to grow rapidly, and the number of publications related to anaesthetic techniques in cardiac catheterization laboratories is substantial. We aim to summarize the most recent evidence about outcomes related to type of anaesthetic in minimally invasive cardiac procedures. The latest studies, primarily focused on transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve repair (TMVr), demonstrate the need for reliable monitoring and appropriate training of the interdisciplinary teams involved in this high-risk NORA setting. Inappropriate sedation and concurrent inadequate oxygenation are main risk factors for claims involving NORA care. Current evidence deriving from TAVR shows that monitored anaesthesia care (MAC) is associated with shorter length of stay and lower mortality.

Paediatric non-operating room anaesthesia-the current scenario

Providing complete and integrated anaesthesia care beyond the protected, familiar and controlled boundary of the traditional operating room setting is a challenge to the anaesthesia provider. Over the past few decades, there has been a tremendous surge in the domains where procedures are being performed under sedation in the paediatric age group- imaging facilities, dental offices, subspecialty procedure suites, emergency departments and ambulatory surgery centres. The number and complexity of such cases is increasing over time. Another major shift has been the changing face of the caregivers. Initially, the anaesthetist played an exclusive role in non-operating room anaesthesia. However, it has now emerged as a multispeciality practice and sedation for children is now being provided by a wide range of specialists around the world. In this article we have discussed the guidelines for practicing paediatric sedation in remote locations and the role of the anaesthetist in the current scenario.

Non-operating Room Anaesthesia Practices in an Endoscopy Unit at a Tertiary Centre: A Retrospective Evaluation

Non-operating Room Anaesthesia Practices in an Endoscopy Unit at a Tertiary Centre: A Retrospective Evaluation

Nonoperating room anaesthesia for elderly patients.

The number of elderly patients receiving non-operating room anaesthesia (NORA) has substantially increased because of clinical, epidemiological, social and economic reasons. Considering the high risk of anaesthesia-related adverse events in this population, along with the limitations of NORA, more specific knowledge and skills are required. Advanced age appears to be an independent risk factor for anaesthesia-related adverse events in a NORA setting, similar to the traditional operating room. As significant changes occur in the pharmacological effects of anaesthetic agents with aging, reducing dosage and carefully titrating drugs are essential. Because NORA-related injury is frequently related to airway obstruction/respiratory depression, non-invasive respiratory activity monitoring is more useful for sedation of elderly patients. Additionally, advanced age increases the risk of aspiration and cognitive complications, even during sedation. Elderly patients may greatly benefit from the lower invasiveness and faster recovery offered by interventional procedures. However, as they represent a highly heterogeneous population with large variations in physiological reserves and comorbidities, anaesthesiologists should strive to maintain the same practice standards throughout all anaesthetizing locations. Knowledge of the unique hazards associated with NORA in elderly patients may further enhance patient safety.Video abstract: NORA for elderly patients.mp4: http://links.lww.com/COAN/A66.

Nonoperating room anaesthesia: safety, monitoring, cognitive aids and severe acute respiratory syndrome coronavirus 2.

Purpose of reviewWith an ageing population, mounting pressure on the healthcare dollar, significant advances in medical technology, and now in the context of coronavirus disease 2019, the traditional paradigm in which operative procedures are undertaken is changing. Increasingly, procedures are performed in more distant, isolated and less familiar locations, challenging anaesthesiologists and requiring well developed situational awareness. This review looks at implications for the practitioner and patient safety, outlining considerations and steps involved in translation of systems and processes well established in the operating room to more unfamiliar environments.Recent findingsDespite limited nonoperating room anaesthesia outcome data, analysis of malpractice claims, anaesthesia-related medical disputes and clinical outcome registries have suggested higher morbidity and mortality. Complications were often associated with suboptimal monitoring, nonadherence to recommended guidelines and sedationist or nonanaesthesiologist caregivers. More recently, clear monitoring guidelines, global patient safety initiatives and widespread implementation of cognitive aids may have contributed to nonoperating room anaesthesia (NORA) outcomes approaching that of traditional operating rooms.SummaryAs NORA caseloads increase, understanding structural and anaesthetic requirements is essential to patient safety. The severe acute respiratory syndrome coronavirus 2 pandemic has provided an opportunity for anaesthesiologists to implement lessons learned from previous analyses, share expertise as patient safety leaders and provide valuable input into protecting patients and caregivers.

Terminology, communication, and information systems in nonoperating room anaesthesia in the COVID-19 era.

Nonoperating room anaesthesia (NORA) is a rapidly growing and important area of anaesthesia care. We would contend that anaesthesia informatics principles and innovations that have been widely applied in numerous diverse domains could be successfully applied in NORA environments, resulting in significant improvements in anaesthesia care delivery. We highlight key recent studies from the perioperative and informatics literature, placing each in the context of how it has, or how it may conceivably be applied to, improved NORA care. There is significant opportunity for anaesthesiologists and clinical informaticians to collaborate and apply major advances in the perioperative informatics field to NORA environments, particularly given rapid recent changes in the field during the COVID-19 epidemic. Given the complexity of NORA patients and care delivered in NORA environments, applied clinical informatics has the potential to drastically improve care delivered.

Non-operating room anaesthesia and difficult airway management in a case of ectopic lingual thyroid planned for magnetic resonance imaging.

Non-operating room anaesthesia and difficult airway management in a case of ectopic lingual thyroid planned for magnetic resonance imaging.

Non-operating room anaesthesia for embolisation of ductus closure device to the pulmonary artery in a child with patent ductus arteriosus - CORRIGENDUM.

ABSTRACTPatent ductus arteriosus is among the most common congenital heart diseases. With the increasing use of transcatheter closure procedures, the incidence of complications related to the procedure has increased. Embolization of the ductus closure device to the pulmonary artery is a very rare complication. Since those procedures are often performed under non-operating room anesthesia, anesthetic management of such patients is of great importance. Herein, anesthetic management of embolization of the ductus closure device to the pulmonary artery in a little girl was presented. This is the first case regarding the anesthetic management of such complication.

The radiation environment of anaesthesiologists in the endoscopic retrograde cholangiopancreatography room

Anaesthesiologists are increasingly involved in nonoperating room anaesthesia (NORA) for fluoroscopic procedures. However, the radiation exposure of medical staff differs among NORA settings. Therefore, we aimed to investigate the radiation environment generated by fluoroscopic endoscopic retrograde cholangiopancreatography (ERCP) and the radiation exposure of anaesthesiologists. The dose area product (DAP), radiation entrance dose (RED), and fluoroscopy time (FT) according to the procedures and monthly cumulative radiation exposure were analysed at two sites (neck and wrist) from 363 procedures in 316 patients performed within 3 months. The total RED and DAP were 43643.1 mGy and 13681.1 Gy cm2, respectively. DAP and RED (r = 0.924) were strongly correlated and DAP and FT (r = 0.701) and RED and FT (r = 0.749) were moderately correlated. The radiation environment per procedure varied widely, DAP and RED per FT were the highest during stent insertion with esophagogastroduodenoscopy. Monthly cumulative deep dose equivalents at the wrist and neck ranged between 0.31–1.27 mSv and 0.33–0.59 mSv, respectively, but they were related to jaw thrust manipulation (r = 0.997, P = 0.047) and not to the radiation environment. The anaesthesiologists may be exposed to high dose of radiation in the ERCP room, which depends on the volume of procedures performed and perhaps the anaesthesiologists’ practice patterns.

Non-operating room anaesthesia in children.

Administration of sedation and/or anaesthesia to patients undergoing painful or uncomfortable procedures at off-site locations is referred to as non-operating room anaesthesia (NORA). Sedating/anaesthetising children in an unfamiliar environment, with the lack of support staff, nonavailability of choice of medication and equipment is often challenging. Studies have shown an increased risk of airway-related adverse events, complications, and even death outside the operating room locations. It is crucial to be familiar with the anatomical and physiological variations in children, well versed with the difficult airway algorithm and call for help early. The most common event in NORA claims was inadequate oxygenation/ventilation, which are preventable with vigilant monitoring. English language articles were searched in Pubmed, Google Scholar, and Academic using 'sedation in children', 'remote location anaesthesia', 'peadiatric sedation', and 'nonoperating room anaesthesia' as the mesh words. Full text of the relevant articles was obtained and this review article was synthesised. The article outlines various safety guidelines, sedation techniques, drugs used for sedation, environmental concerns, procedure-specific risks, and complications associated with NORA in children.

The Attitudes and Behaviors of Anaesthesiology and Reanimation Specialists in Anaesthesia Care Applications Outside the Operating Room in Turkey: A Survey Study.

We aimed to investigate the attitudes and behaviors of anaesthesiologists in "non-operating room anaesthesia" applications, which can be described as anaesthesia applications performed outside the operating room, and their reflection on practice all over Turkey. Our study was conducted between November 5, 2012 and January 7, 2013 with the approval of the Research Ethics Board. Survey data were obtained through distributing printed questionnaires to be completed either by hand or via the web. The questionnaire consisted of 38 questions. The data obtained were analyzed with the Statistical Package for Social Sciences (SPSS) program. A total of 500 anaesthesiologists replied to our survey; 93% of anaesthesia specialists reported that there was a request that the anaesthesia and anaesthesia outside the operating room was given in their institution. Among anaesthesiologists, 56% reported that there were other sections that can provide sedation other than the anaesthesiology department in their institutions. Anaesthesia care team members; equipment; anaesthetic techniques; monitoring methods; and hypnotic, analgesic, and antagonist agents had statistically significant differences according to the participants' institutions. Equipment used in the anaesthesia practice outside the operating room, anaesthesia, and monitoring methods had statistically significant differences according to geographical distribution (p<0.05). Outside the operating room, anaesthesia practices and security measures are compliant with the standards set by the guidelines, the key to the prevention of complications. In our study, the current status of anaesthetic procedures outside the operating room in our country have been analyzed.

Anaesthetist support during sedation for patients undergoing minimally invasive procedures outside the operating room

Anaesthetist support during sedation for patients undergoing minimally invasive procedures outside the operating room

Risk and safety of anaesthesia outside the operating room

To evaluate the risks and safety of anaesthesia performed outside the operating room. Very little information and hard data are available. However, paediatric patients are often involved in complications, substandard care is often prominent and inadequate monitoring is often a contributory factor. The risk of complications is higher with nonoperating room anaesthesia than with anaesthesia inside the operating room. There is an urgent need for good data on complications with anaesthesia outside the operating room.