Processes should not change for NORA

  • Managing Patients in the NORA Settings of the Cardiology, Interventional Radiology, Bronchoscopy and Gastroenterology Suites (PN415)
  • 1-3 p.m. Tuesday
  • BCEC Room 102AB

Anesthesia is increasingly being used outside the operating room in suites designed for less invasive procedures. The change of scenery still requires the use of standard anesthesiology processes and creates new challenges, which will be explored in a Tuesday education session.

“Nonoperating room anesthesia (NORA) is an exploding part of our portfolio,” said session moderator Thomas W. Cutter, M.D. “We have to provide anesthesia for more patients and more procedures. Oftentimes, these patients are too sick and would not tolerate an open procedure, so they have a less invasive procedure.

Thomas W. Cutter, M.D.

“If they are deemed too sick to have the open procedure, they are not less sick. The anesthetic provision for these patients can be as challenging — if not more challenging — as for the less invasive procedure.”

Three speakers will review the correct processes to follow for less invasive procedures. They also will explain the specific challenges for gastroenterology, cardiology, interventional radiology and bronchoscopy/pulmonary procedures.

“We will concentrate on NORA for ambulatory procedures and for more complex procedures,” said Dr. Cutter, Professor of Anesthesia and Critical Care at the Pritzker School of Medicine, University Chicago. “We will include the appropriate preparation of the patient during the preoperative phase, how the anesthetic will be conducted intraoperatively and then management post-procedure.”

The cardiology presentation will highlight the evolving role of anesthesiology in electrophysiology procedures, particularly outpatient or 23-hour admissions. Other topics will include supraventricular tachycardia, atrial fibrillation and ventricular tachycardia ablations, subcutaneous defibrillator placement and managing ischemic disease for high-risk PCI patients with Impella support.

Gastroenterology procedures include endoscopic retrograde cholangiopancreatography (ERCP), colonoscopies, and routine and advanced upper endoscopies, with a focus on patient selection.

The interventional radiology presentation will review patient risks and challenges for anesthesiologists. Procedures that will be examined include kyphoplasty, ablations, stent, catheter and drain placement, and endoscopy procedures.

The bronchoscopy presentation will focus on the evolving role of anesthesiologists in interventional pulmonology procedures. They include bronchial thermoplasty for severe persistent asthma, endobronchial ultrasound and transbronchial biopsy, rigid bronchoscopy and tracheal stent placement.

“You should never compromise your care, even if you are not in your traditional operating room,” Dr. Cutter said. “You need to maintain the same standard of care for any procedure anywhere. The equipment should be set up in the same fashion, as well as the support resources, protocols, etc. The level of care should be the same in this setting as anywhere else.”

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