Anesthesiology clinics
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In the setting of technological advancements in imaging and intervention with concomitant rise in the use of non-operating room anesthesia (NORA) care, it has become even more critical for anesthesiologists to be aware of the needs and limitations of interventional procedures performed outside of the operating room. This article addresses the use of NORA services from the interventional radiologist's point of view and provides specific examples of preprocedural, intraprocedural, and postprocedural care patients may need for optimal outcome.
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Anesthesiology clinics · Dec 2017
ReviewBuilding and Maintaining Organizational Infrastructure to Attain Clinical Excellence.
Active maintenance of highly functional teams is critical to ensuring safe, efficient patient care in the non-operating room anesthesia (NORA) suite. In addition to developing collaborative relationships and patient care protocols, individual and team training is needed. ⋯ The training should be supplemented with continuing education in this field for providers who find themselves working in the NORA space. As NORA continues to grow, robust NORA-specific quality assurance and improvement programs will empower anesthesiologists with the tools they need to best care for these patients.
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Anesthesiology clinics · Dec 2017
ReviewCatheterization Laboratory: Structural Heart Disease, Devices, and Transcatheter Aortic Valve Replacement.
The cardiac catheterization laboratory is advancing medicine by performing procedures on patients who would usually require sternotomy and cardiopulmonary bypass. These procedures are done percutaneously, allowing them to be performed on patients considered inoperable. Patients have compromised cardiovascular function or advanced age. ⋯ Interventionalists are becoming more familiar with transcatheter aortic valve replacement and the device has become smaller, both contributing to less complications. Left atrial occlusion and the endovascular edge-to-edge mitral valve repair devices were approved. Although these devices require general anesthesia, an invasive surgery and cardiopulmonary bypass machine are not necessary for deployment.
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Procedures requiring nonoperating room anesthesia (NORA) continue to increase in quantity and complexity. The roles of anesthesiologists as members of care teams in nonoperating room locations continue to evolve. ⋯ Body temperature should also be measured in appropriate scenarios. High-risk anesthetics require advanced preparation and monitoring.
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Anesthesiology clinics · Dec 2017
ReviewSafety of Non-Operating Room Anesthesia: A Closed Claims Update.
Malpractice claims for non-operating room anesthesia care (NORA) had a higher proportion of claims for death than claims in operating rooms (ORs). NORA claims most frequently involved monitored anesthesia care. ⋯ The proportion of claims in cardiology and radiology NORA locations were increased compared with estimates of cases in these locations. Although NORA is safe, adherence to safe clinical practice is important.