Nonoperating room anesthesia for children.

PURPOSE OF REVIEW: With the continuous development of technological advances for diagnosis and treatment comes the increased need for anesthesia outside of the operating room. Children, because of their inability to cooperate with lengthy imaging procedures or painful treatments, form the largest group needing non operating room anesthesia (NORA). As the distinction between deep sedation and general anesthesia becomes less clear, it has become increasingly common for institutions to dedicate resources for pediatric NORA (as opposed to sedation services) to improve predictability, comfort, and safety.

RECENT FINDINGS: Anesthesia away from the operating room must meet all standards mandated for general anesthesia in the operating suite. In addition, NORA teams must meet non anesthesia specialty guidelines and requirements of the Joint Commission for the Accreditation of Healthcare Organizations. The complexities and hazards of distinct environments must be met and technical support provided. Communication, backup, and emergency systems must be integrated, often at significant geographical distances from central anesthesia services. Anesthesia personnel are often required to interact in multiple roles that may be unfamiliar.

SUMMARY: NORA is a specific microsystem environment that must integrate operating room systems with those of other departments and specialties. Often the children that require these procedures have chronic illnesses and return at frequent intervals with complex medical, psychological, and behavioral issues. Special knowledge, training, and support infrastructure are required to provide optimal care for these expanding services.