Nonoperating Room Anesthesia: What Is New? What Is Controversial?

• Published in: Current anesthesiology reports (Philadelphia) Vol. 14; no. 1; pp. 101 - 109
• Main Authors: Bridges, Kathryn Harter, Wilson, Phillip Ryan, Tobin, Catherine Dawson
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.03.2024
• Subjects: Ambulatory Anesthesia (G Joshi; Anesthesiology; Critical Care Medicine; Intensive; Internal Medicine; Medicine; Medicine & Public Health; Section Editor; Electrophysiology; Hydrotherapy; Glucagon-like peptide-1 receptor agonists; Peroral endoscopic myotomy; Endoscopic lung volume reduction; Nonoperating room anesthesia
• ISSN: 2167-6275; 2167-6275
• DOI: 10.1007/s40140-023-00596-8

Purpose of Review Nonoperating room anesthesia (NORA) represents a diverse and growing subset of anesthetic practice, with new, increasingly complex procedures rapidly developing. This paper serves to highlight key newer procedures and discuss common areas of controversy within the NORA subspecialties. Recent Findings Featured new procedures include pulsed field ablation, primary obesity surgery endoluminal (POSE), peroral endoscopic myotomy (POEM), endoscopic lung volume reduction (ELVR), and pulmonary cryospray. Featured controversial topics include outpatient and ambulatory atrial fibrillation ablation, glucagon-like peptide-1 (GLP-1) receptor agonist management within endoscopy, and airway selection for bronchoscopy. Summary Atrial fibrillation ablation can be a safe same-day discharge procedure and potentially performed at ambulatory centers. GLP-1 receptor agonists present heightened risk for retained stomach contents and potentially aspiration. ELVR is potentially a safer alternative to traditional surgical approach. Intensive care unit-based procedures can provide simpler, timely care but may require protocolization and clear team communication to address common safety concerns.