Nonoperating room anesthesia in the ICU: current practice and considerations

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Procedural Sedation

Background:

• Intensive care unit (ICU) procedures are becoming more complex, often necessitating deep sedation or general anesthesia.
• Bedside procedures are preferred to minimize transport risks for critically ill patients.
• This has expanded the role of anesthesiologists in non-operating room anesthesia (NORA) within the ICU.

Purpose of the Study:

• To review practical anesthetic considerations for bedside ICU procedures.
• Focus on optimization, monitoring, and systems issues in ICU NORA.
• Provide guidance for anesthesiologists managing complex ICU cases.

Main Methods:

• Review of current literature and practices in ICU NORA.
• Analysis of anesthetic challenges in critically ill patients.
• Summary of strategies to mitigate risks and improve outcomes.

Main Results:

• ICU patients present unique challenges including shock, hypoxemia, and organ dysfunction affecting anesthetic responses.
• Bedside procedures like tracheostomy, ECMO cannulation, and bronchoscopy have higher cardiorespiratory event rates.
• Strategies such as short-acting agents, noninvasive support, checklists, and simulation can reduce complications.
• Artificial intelligence and machine learning show promise for risk stratification and decision support.

Conclusions:

• Bedside ICU procedures necessitate careful planning, bridging sedation and general anesthesia.
• Individualized anesthetic plans, clear rescue protocols, and interdisciplinary coordination are essential.
• Advanced monitoring and data-driven decision support are key to safe and effective ICU NORA.