Sedation technique considerations for nonoperating room anesthesia: a narrative review and update

Sedation techniques for nonoperating room anesthesia (NORA) are vital for ensuring patient comfort and cooperation during diagnostic and therapeutic procedures outside traditional operating rooms. The increasing prevalence of these procedures in diverse settings necessitates adapting sedation practices to unique challenges in monitoring, equipment availability, and emergency preparedness.

The choice of sedation technique depends on the procedure, patient health status, and the nonsurgical environment's resources. Common techniques include moderate sedation, deep sedation, and general anesthesia. Agents like propofol, dexmedetomidine, fentanyl, and midazolam are frequently used due to their rapid onset, short half-lives, and predictable three pharmacokinetics. Balanced sedation techniques combining agents help minimize side effects while achieving desired sedation levels.

To maintain safety and efficacy, NORA practices must adhere to the same high standards as operating rooms, including sedation protocols and American Society of Anesthesiologists standard monitoring. Portable monitoring systems and robust emergency preparedness are essential in these settings. As NORA cases rise, the development of tailored sedation protocols and refinement of safety standards are crucial to enhancing patient outcomes in diverse procedural environments.