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    Non-Operating Room Anesthesia: April 2017

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    Eolia Effendi
    This document is a conference paper from 2017 about non-operating room anesthesia (NORA). It discusses how NORA involves anesthesia care outside of operating rooms, including definitions of terms like monitored anesthesia care and anesthesia outside operating rooms. It also covers topics like appropriate sedation levels, safety issues found in closed claims studies involving NORA, guidelines and recommendations for NORA, and the importance of teamwork in NORA environments. The author is Alessandro Bacuzzi and it was presented at the Varese University Hospital in Italy.

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    Non-Operating Room Anesthesia: April 2017

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    Eolia Effendi
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    This document is a conference paper from 2017 about non-operating room anesthesia (NORA). It discusses how NORA involves anesthesia care outside of operating rooms, including definitions of terms like monitored anesthesia care and anesthesia outside operating rooms. It also covers topics like appropriate sedation levels, safety issues found in closed claims studies involving NORA, guidelines and recommendations for NORA, and the importance of teamwork in NORA environments. The author is Alessandro Bacuzzi and it was presented at the Varese University Hospital in Italy.

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    This document is a conference paper from 2017 about non-operating room anesthesia (NORA). It discusses how NORA involves anesthesia care outside of operating rooms, including definitions of terms like monitored anesthesia care and anesthesia outside operating rooms. It also covers topics like appropriate sedation levels, safety issues found in closed claims studies involving NORA, guidelines and recommendations for NORA, and the importance of teamwork in NORA environments. The author is Alessandro Bacuzzi and it was presented at the Varese University Hospital in Italy.

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    © All Rights Reserved
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    16 views26 pages

    Non-Operating Room Anesthesia: April 2017

    Uploaded by

    Eolia Effendi
    This document is a conference paper from 2017 about non-operating room anesthesia (NORA). It discusses how NORA involves anesthesia care outside of operating rooms, including definitions of terms like monitored anesthesia care and anesthesia outside operating rooms. It also covers topics like appropriate sedation levels, safety issues found in closed claims studies involving NORA, guidelines and recommendations for NORA, and the importance of teamwork in NORA environments. The author is Alessandro Bacuzzi and it was presented at the Varese University Hospital in Italy.

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    Non-operating room anesthesia

    Conference Paper · April 2017

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    L’ASSISTENZA
    ANESTESIOLOGICA

    VIIIa SESSIONE: HOT TOPICS

    Alessandro BACUZZI
    S.C. Anestesia, Rianimazione e Cure Palliative
    Direttore: Salvatore CUFFARI
    Introduction

    S.C. Anestesia, Rianimazione e Cure Palliative


    Introduction

    S.C. Anestesia, Rianimazione e Cure Palliative


    Non Operating Room Anesthesia (NORA)

    NORA
    (MAC) monitored anesthesia care

    (AOOR) anesthesia outside operating room

    NORA

    “Away from the O.R. and closer to the


    patient”
    Pomerantz P. ASA CEO American Society of Anesthesiologists Newsletter 2013; 77:8–9

    S.C. Anestesia, Rianimazione e Cure Palliative


    Non Operating Room Anesthesia (NORA)

    Remifentanyl Alfentanyl Fentanyl

    Bolus vs continuous infusion

    2009
    Minimal Moderate
    Deep sedation/
    Continuum of depth of Sedation Sedation / Analgesia General Anesthesia
    Analgesia
    (anxiolysis) (“conscious sedation”)
    sedation

    Normal Purposeful
    Unarousable even
    response to Purposeful response to response following
    Responsiveness with painful
    verbal verbal or tactile stimulation repeated or painful
    stimulus
    stimulation stimulation

    Intervention may be Intervention


    Airway Unaffected No intervention required
    required required

    Spontaneous Ventilation Unaffected Adequate May be inadequate Inadequate

    Cardiovascular Function Unaffected Usually maintained Usually maintained May be impaired

    S.C. Anestesia, Rianimazione e Cure Palliative


    Non Operating Room Anesthesia (NORA)

    (Anesth Analg 1994;78:354-8)

    Isobolographic analysis
    Sedative Combinations Produce Variable Synergism

    Alfentanil antinociceptive component of anesthesia


    Propofol hypnotic component,
    Midazolam pronounced amnestic property.

    S.C. Anestesia, Rianimazione e Cure Palliative


    NORA & Safety

    Anesthesia Closed Claims Project


    Department of Anesthesiology and
    Pain Medicine
    University of Washington
    Box 356540
    Seattle, WA 98195-6540

    S.C. Anestesia, Rianimazione e Cure Palliative


    NORA & Safety

    S.C. Anestesia, Rianimazione e Cure Palliative


    NORA & Safety

    Inclusion criteria for the current study were claims forevents that occurred in 1990 or later.

    Exclusion criteria were obstetric claims (vaginal delivery and cesarean section) and claims arising from acute or chronic pain
    management.

    Remote location claims were identified by location (e.g. emergency room) or procedures that are commonly performed in remote
    locations (e.g. cardiology, gastrointestinal, imaging, and lithotripsy).

    The comparison group of operating room claims included all other claims in the database that satisfied inclusion and exclusion
    criteria.

    The physical or psychological injury for which the patient was seeking compensation was recorded in each claim.

    Each claim was assigned a severity of injury score using the insurance industry’s 10-point scale that rates severity from zero (no
    injury) to nine (death). For purposes of analysis, injuries were grouped into three categories:
    temporary or nondisabling (score 0–5),
    disabling and permanent (score 6–8),
    and death (score 9).

    Patients’ injuries were judged by the on-site reviewer for theoretical preventability by the use of additional and improved monitoring
    techniques, such as pulse oximetry and capnography, assuming optimal use of these techniques.

    S.C. Anestesia, Rianimazione e Cure Palliative


    NORA & Safety

    S.C. Anestesia, Rianimazione e Cure Palliative


    NORA & Safety

    S.C. Anestesia, Rianimazione e Cure Palliative


    NORA: guidelines & recommendations

    S.C. Anestesia, Rianimazione e Cure Palliative


    NORA: guidelines & recommendations

    S.C. Anestesia, Rianimazione e Cure Palliative


    NORA: guidelines & recommendations

    S.C. Anestesia, Rianimazione e Cure Palliative


    NORA: guidelines & recommendations

    S.C. Anestesia, Rianimazione e Cure Palliative


    NORA: guidelines & recommendations

    S.C. Anestesia, Rianimazione e Cure Palliative


    NORA: guidelines & recommendations

    S.C. Anestesia, Rianimazione e Cure Palliative


    NORA: guidelines & recommendations

    S.C. Anestesia, Rianimazione e Cure Palliative


    Non Operating Room Anesthesia (NORA)

    S.C. Anestesia, Rianimazione e Cure Palliative


    Non Operating Room Anesthesia (NORA)

    S.C. Anestesia, Rianimazione e Cure Palliative


    Non Operating Room Anesthesia (NORA)

    S.C. Anestesia, Rianimazione e Cure Palliative


    Non Operating Room Anesthesia (NORA)

    S.C. Anestesia, Rianimazione e Cure Palliative


    Conclusion

    • NORA: a specific anesthesia service in which an anesthesiologist has been requested to


    participate in the care of a patient undergoing a diagnostic or therapeutic procedure.

    • Anesthesia at remote locations poses a significant risk for the patient. Sources of risk include
    the patient’s medical status, the procedure, the anesthetic, the equipment and the environment. Similar
    anesthesia and monitoring standards and guidelines should be used in all anesthesia care areas.

    • Every anesthesia service should draw up an organization model for anesthesia procedures
    performed in nonoperating room locations in relation to hospital set up and design and type and
    frequency of services ordered.

    • Not Them, Not Us, But We: the Importance of teamwork in the NORA environment.
    Collaborative action has led to better patient care and quality management.

    S.C. Anestesia, Rianimazione e Cure Palliative


    Conclusion

    S.C. Anestesia, Rianimazione e Cure Palliative


    Thanks

    [email protected]

    S.C. Anestesia, Rianimazione e Cure Palliative


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