• Grace Shih and Philip D Bailey.
• Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, The University of Pennsylvania and The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
• Curr Opin Anaesthesiol. 2020 Aug 1; 33 (4): 584-588.

Purpose Of ReviewNonoperating room anesthesia (NORA) cases performed in pediatric patients have increased over the past decade. It is imperative for the anesthesia provider to be familiar with the nuances of this environment and the myriad of cases to ensure delivery of safe and efficient care.Recent FindingsThough case volume has increased, sedative agents have largely remained unchanged. NORA sites must meet the same operating room standards and expectations of anesthesia established by the American Society of Anesthesiologists. Despite the increasing NORA volume and efforts to instill a similar culture of safety as the operating room complex, NORA cases present challenges with limited resources and access to the patient, highlighting the need for resident and fellow training to include NORA experiences.SummaryExperience working in the NORA environment helps provide, maintain, and improve the cognitive fitness and resilience that an anesthesiologist needs to tackle the complexities from the variety of NORA cases and locations. Patient factors aside, procedural considerations can affect the anesthetic plan, so understanding the nuances of the procedure helps the anesthesia provider provide safe and efficient care.

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