Standard procedures in nonoperating room anesthesia

This article provides an overview of standard procedures currently performed in nonoperating room anesthesia (NORA) and highlights anesthetic implications.

Novel noninvasive interventional procedures remain on the rise, accelerating demand for anesthesia support outside the conventional operating room. The field of interventional oncology has introduced a variety of effective minimally invasive therapies making interventional radiology gain a major role in the management of cancer. Technical innovation brings newer ablative and embolotherapy techniques into practice. Flexible bronchoscopy has replaced rigid bronchoscopy for many diagnostic and therapeutic indications. Endobronchial ultrasonography now allows sampling of mediastinal, paratracheal, or subcarinal lymph nodes rendering more invasive procedures such as mediastinoscopy unnecessary. Similarly, endoscopic ultrasonosgraphy currently plays a central position in the management of gastrointestinal disease. Sophisticated catheter techniques for ablating cardiac arrhythmias have become state of the art; Watchman procedure gaining position in the prevention of stroke resulting from atrial fibrillation.

NORA is a rapidly evolving field in anesthesia. Employing new technology to treat a wide variety of diseases brings new challenges to the anesthesiologist. Better understanding of emerging interventional techniques is key to safe practice and allows the anesthesia expert to be at the forefront of this swiftly expanding multidisciplinary arena.