NORA SOCIETY

Working together to enhance patient safety, quality of care, and education in Non-Operating Room Anesthesia

NORA PUBLICATIONS

  1. Anca D, Reyes O, Mitra RL, Epstein LM, Shore-Lesserson L. Electrophysiology Practice During COVID-19 Pandemic: A New York Tertiary Hospital Experience. J Cardiothorac Vasc Anesth. 2021;35(5):1281-1285. doi:10.1053/j.jvca.2020.10.041

    • This article describes how a New York tertiary care hospital adapted its electrophysiology services during the COVID-19 pandemic by prioritizing urgent procedures, incorporating telehealth, and implementing strict infection control measures. The experience highlights strategies that maintained essential cardiac care while minimizing viral exposure risk.

    • Link to article)

  2. Gabriels JK, Ying X, Purkayastha S, et al. Safety and Efficacy of a Novel Approach to Pulmonary Vein Isolation Using Prolonged Apneic Oxygenation. JACC Clin Electrophysiol. 2023;9(4):497-507. doi:10.1016/j.jacep.2022.10.030

    • This study evaluates a novel technique for pulmonary vein isolation using prolonged apneic oxygenation, demonstrating that it is both a safe and effective strategy for minimizing respiratory movement during ablation, thereby enhancing procedural precision and outcomes.

    • Link to article)

  3. Miyara SJ, Guevara S, Shore-Lesserson L, et al. Right Ventricle Embolization of IVC Filter Fragments: An Incidental Finding. International Journal of Angiology. 2021;34(02):100-104. doi:10.1055/S-0041-1730451/ID/JR210022-25/BIB

    • This case report discusses an incidental finding of embolized inferior vena cava (IVC) filter fragments lodged in the right ventricle, emphasizing the importance of vigilance and imaging in asymptomatic patients with IVC filters.

    • Link to Article)

  4. Munoz-Acuna R, Rady A. Non-operating Room Cardiac Procedures in Elderly: Update and Challenges. Curr Anesthesiol Rep. 2025;15(1):29. doi:10.1007/s40140-025-00691-y

    • The article highlights the increasing use of cardiac procedures in non-operating room settings for elderly patients, discussing recent advances and unique anesthetic and perioperative challenges associated with this vulnerable population.

    • Link to article) – Account/subscription needed for full access

  5. Sharma D, Rasmussen M, Han R, et al. Anesthetic Management of Endovascular Treatment of Acute Ischemic Stroke during COVID-19 Pandemic: Consensus Statement from Society for Neuroscience in Anesthesiology & Critical Care (SNACC). J Neurosurg Anesthesiol. 2020;32(3):193-201. doi:10.1097/ANA.0000000000000688,

    • This consensus statement provides guidance on the anesthetic care of acute ischemic stroke patients undergoing endovascular therapy during the COVID-19 pandemic, balancing safety, infection control, and timely neurological intervention.

    • Link to article)

  6. Siegrist KK, Fernandez Robles C, Kertai MD, Oprea AD. The Electrophysiology Laboratory: Anesthetic Considerations and Staffing Models. J Cardiothorac Vasc Anesth. 2021;35(9):2775-2783. doi:10.1053/j.jvca.2021.02.050

    • This review outlines key anesthetic considerations and staffing models in electrophysiology labs, emphasizing the complexity of procedures and the need for interdisciplinary coordination to ensure patient safety and procedural success.

    • Link to article

  7. Talke PO, Sharma D, Heyer EJ, Bergese SD, Blackham KA, Stevens RD. Society for neuroscience in anesthesiology and critical care expert consensus statement: Anesthetic management of endovascular treatment for acute ischemic stroke: Endorsed by the society of NeuroInterventional surgery and the neurocritical care society. J Neurosurg Anesthesiol. 2014;26(2):95-108. doi:10.1097/ANA.0000000000000042,

    • An expert consensus statement offering evidence-based recommendations for the anesthetic management of acute ischemic stroke patients undergoing endovascular treatment, endorsed by multiple professional societies to standardize care.

    • Link to article

  1. Utilizing Problem-Based Learning in Anesthesiology Careers (2021)

  1. Armas A, Primm AN. Anesthetic Management of a Patient With an Anterior Mediastinal Mass Undergoing Endoscopic Retrograde Cholangiopancreatography in the Prone Position: A Case Report. A A Pract. 2019;14(1):25. doi:10.1213/XAA.0000000000001142

    • This case report describes the anesthetic challenges and risk mitigation strategies for safely managing a patient with an anterior mediastinal mass undergoing ERCP in the prone position, highlighting airway and hemodynamic considerations.

    • Link to article

  2. Baig MU, Piazza A, Lahooti A, et al. Glucagon-like peptide-1 receptor agonist use and the risk of residual gastric contents and aspiration in patients undergoing GI endoscopy: a systematic review and a meta-analysis. Gastrointest Endosc. 2025;101(4):762-771.e13. doi:10.1016/j.gie.2024.12.019

    • This meta-analysis evaluates the association between GLP-1 receptor agonist use and the presence of residual gastric contents during GI endoscopy, finding a potential increased aspiration risk and supporting adjusted periendoscopic fasting protocols.

    • Link to article

  3. Hagan KB, Carlson R, Arnold B, et al. Safety of the LMA®GastroTM for Endoscopic Retrograde Cholangiopancreatography. Anesth Analg. 2020;131(5):1566-1572. doi:10.1213/ANE.0000000000005183,

    • The study investigates the safety profile of the LMA®Gastro™ during ERCP procedures, concluding that it provides effective airway management with low complication rates, even in high-risk patients.

    • Link to article

  4. Primm A. How to Stay Safe During Advanced Endoscopic GI Procedures. 2024. Accessed June 22, 2025. https://www.anesthesiologynews.com/Multimedia/Article/03-25/How-to-Stay-Safe-During-Advanced-Endoscopic-GI-Procedures/76537

    • This article offers practical safety tips for anesthesia providers involved in complex GI endoscopic procedures, focusing on patient selection, sedation strategies, and interdisciplinary communication.

    • Link to article

  5. Sharaiha RZ, Shukla AP, Sen S, et al. American Society for Gastrointestinal Endoscopy position statement on periendoscopic management of patients on glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors. Gastrointest Endosc. 2025;101(2):285-294. doi:10.1016/j.gie.2024.10.057

    • This position statement by the ASGE provides guidance on managing patients taking GLP-1 receptor agonists and SGLT2 inhibitors before endoscopy, recommending tailored timing of medication cessation to reduce procedural risks.

    • Link to article

  6.  Safety of the LMA®Gastro™ for Endoscopic Retrograde Cholangiopancreatography (2020)
  7. Anesthetic Management of a Patient With an Anterior Mediastinal Mass Undergoing Endoscopic Retrograde Cholangiopancreatography in the Prone Position: A Case Report (2019)
  1. Nonoperating room anesthesia in different parts of the world (2020)
  1. Beg T, Daoud BE, Richman DC. Preoperative optimization of patients undergoing interventional procedures: infrastructure, logistics, and evidence-based medicine. Curr Opin Anaesthesiol. 2021;34(4):482-489.

    • This article outlines the importance of systematic preoperative optimization for patients undergoing interventional procedures, emphasizing infrastructure needs, coordinated logistics, and evidence-based protocols to enhance safety and outcomes.

    • Link to article

  2. Chang B, Kaye AD, Diaz JH, Westlake B, Dutton RP, Urman RD. Interventional Procedures Outside of the Operating Room: Results From the National Anesthesia Clinical Outcomes Registry. J Patient Saf. 2018;14(1):9-16. doi:10.1097/PTS.0000000000000156

    • Using national registry data, this study analyzes anesthesia-related outcomes in non-OR settings, highlighting safety trends and variability in complication rates across different procedure types and environments.

    • Link to article

  3. Fernandez-Robles C, Oprea AD. Nonoperating room anesthesia in different parts of the world. Curr Opin Anaesthesiol. 2020;33(4):520-526. doi:10.1097/ACO.0000000000000886,

    • This review examines global perspectives on NORA practice, exploring regional differences in infrastructure, provider roles, and safety protocols, and emphasizing the need for standardization to reduce variability.

    • Link to article

  4. Latzman JA, Castellanos JG, Anca D. Using checklists to improve care in the nonoperating room environment. Curr Opin Anaesthesiol. 2022;35(4):479-484. doi:10.1097/ACO.0000000000001154

    • The article advocates for the implementation of structured checklists in NORA settings to enhance patient safety, improve team communication, and minimize preventable errors during complex procedures.

    • Link to article

  5. Moody A, Chacin B, Chang C. Preventing patient positioning injuries in the nonoperating room setting. Curr Opin Anaesthesiol. 2022;35(4):465-471. doi:10.1097/ACO.0000000000001153

    • This review addresses the risks of patient positioning injuries during NORA procedures and provides evidence-based strategies for prevention, including tailored positioning techniques and heightened vigilance.

    • Link to article

  6. Nagrebetsky A, Gabriel RA, Dutton RP, Urman RD. Growth of nonoperating room anesthesia care in the United States: A contemporary trends analysis. Anesth Analg. 2017;124(4):1261-1267. doi:10.1213/ANE.0000000000001734,

    • This trends analysis documents the rapid growth of NORA services in the U.S., examining factors driving this expansion and the associated implications for anesthesia staffing, safety, and policy development.

    • Link to article

  7. Schumacher P. No Joke: UCLA Health Team Proves It’s Possible to Perform High-Acuity Anesthesia Procedures Outside the OR. ASA Monitor. 2024;88(12):30-31. doi:10.1097/01.ASM.0001095352.01607.23

    • This brief report showcases UCLA’s successful implementation of high-acuity anesthesia care in non-OR settings, demonstrating that with appropriate planning and staffing, complex cases can be safely managed outside traditional ORs.

    • Link to article – Account/subscription needed for full access

  1. Growth of Nonoperating Room Anesthesia Care in the United States: A Contemporary Trends Analysis (2017)
  1. Anesthesia care in the interventional neuroradiology suite: an update (2022)
  2. Anesthetic Management of Endovascular Treatment of Acute Ischemic Stroke During COVID-19 Pandemic: Consensus Statement From Society for Neuroscience in Anesthesiology & Critical Care (SNACC) (2020)
  3. Society for Neuroscience in Anesthesiology and Critical Care Expert Consensus Statement: Anesthetic Management of Endovascular Treatment for Acute Ischemic Stroke (2014)

  1. Anca D, Pua B, Fogarty Mack P. NORA: Considerations during COVID 19 Pandemic–The New York Experience. Perioper Care Oper Room Manag. 2021;22. doi:10.1016/j.pcorm.2020.100148

    • This article describes adaptations in NORA workflows during the COVID-19 pandemic in a New York hospital, focusing on infection control, case prioritization, and interdisciplinary coordination to maintain patient and provider safety.

    • Link to article

  2. Chang C, Dudley R. Time-Out Checklists Promote Safety in Nonoperating Room Anesthesia (NORA) – Anesthesia Patient Safety Foundation. Anesthesia Patient Safety Foundation. 2021;36(3). Accessed June 24, 2025. https://www.apsf.org/article/time-out-checklists-promote-safety-in-nonoperating-room-anesthesia-nora/

    • This article from the APSF emphasizes the use of time-out checklists in NORA settings to reduce communication errors and improve procedural safety, especially in high-risk, fast-paced environments.

    • Link to article

  3. Chang C, Tan J, Fogarty MP, Anca D. Clinician Safety in NORA. APSF Newsletter. Published online October 2023:84-86.

    • The piece discusses challenges to clinician safety in NORA environments, including physical layout issues, equipment limitations, and the importance of systemic support for provider well-being.

    • Link to article

  4. DePeau M. Anesthesia Outside of the OR: Cause for Patient Safety Concerns? | MedPage Today. January 23, 2023. Accessed June 22, 2025. https://www.medpagetoday.com/special-reports/exclusives/102632

    • This investigative article raises awareness about safety risks in anesthesia delivered outside traditional ORs, highlighting real-world complications and calls for stricter standards and oversight.

    • Link to article – Account/subscription needed for full access

  5. Khan R, Sun KJ, O’Connor M, Leung JM. A Scoping Review on the Incidence of Nonoperating Room Anesthesia Safety Events. J Patient Saf. Published online March 31, 2025. doi:10.1097/PTS.0000000000001342

    • This scoping review compiles and analyzes data on safety events in NORA, identifying common incident types and knowledge gaps, and suggesting a need for improved reporting systems and standardized safety protocols.

    • Link to article

  6. Mack PF. Medication safety in nonoperating room anesthesiology. Curr Opin Anaesthesiol. 2021;34(4):443-448. doi:10.1097/ACO.0000000000001015

  7. Primm A, Anca D. Updates in Non-Operating Room Anesthesia. Curr Opin Anaesthesiol. 2025;38(3):297-302. doi:10.1097/ACO.0000000000001472

    • This review outlines recent advances in NORA, including improved monitoring technology, workflow innovations, and evolving guidelines that aim to match OR-level safety in alternative procedure environments.

    • Link to article

  8. Saksa D, Khan R, Primm A. Provider and Patient Safety in Non-Operating Room Anesthesia Locations – OpenAnesthesia. 2024. Accessed June 22, 2025. https://www.openanesthesia.org/keywords/provider-and-patient-safety-in-non-operating-room-anesthesia-locations/

    • This educational resource outlines key safety challenges unique to NORA, advocating for risk awareness, checklist use, and system-based approaches to safeguard both patients and healthcare workers.

    • Link to article – Account/subscription needed for full access

  9. Schroeck H, Boone MD, Rubenberg LA, Bryan YF. Anesthesia Emergencies in Hybrid Operating Rooms: Multidisciplinary Crisis Resource Management – Anesthesia Patient Safety Foundation. September 8, 2020. Accessed June 22, 2025. https://www.apsf.org/article/anesthesia-emergencies-in-hybrid-operating-rooms-multidisciplinary-crisis-resource-management/

    • This article emphasizes the role of crisis resource management in hybrid ORs, detailing team-based approaches to managing anesthesia emergencies and ensuring coordinated responses in complex settings.

    • Link to article

  10. Schroeck H, Whitty MA, Martinez-Camblor P, Voicu S, Burian BK, Taenzer AH. Anaesthesia clinicians’ perception of safety, workload, anxiety, and stress in a remote hybrid suite compared with the operating room. Br J Anaesth. 2023;131(3):598-606. doi:10.1016/j.bja.2023.04.028

    • This study compares clinician perceptions in remote hybrid suites versus traditional ORs, revealing increased stress and workload in remote settings and underscoring the need for ergonomic and organizational improvements.

    • Link to article

  11. Woodward ZG, Urman RD, Domino KB. Safety of Non–Operating Room Anesthesia: A Closed Claims Update. Anesthesiol Clin. 2017;35(4):569-581. doi:10.1016/J.ANCLIN.2017.07.003

    • A review of closed malpractice claims in NORA settings reveals patterns in adverse outcomes and emphasizes targeted interventions—like airway management training and risk-based case selection—to improve patient safety.

    • Link to article

  12. Consensus Recommendations for the Safe Conduct of Nonoperating Room Anesthesia: A Meeting Report From the 2022 Stoelting Conference of the Anesthesia Patient Safety Foundation
  13. Provider Safety in NORA
  14. Interventional Procedures Outside of the Operating Room: Results From the National Anesthesia Clinical Outcomes Registry (2018)
  15. Safety of Non-Operating Room Anesthesia: A Closed Claims Update (2017)
  16. Medication safety in nonoperating room anesthesiology (2021)
  17. Anesthesia Outside of the OR: Cause for Patient Safety Concerns? (2023)
  18. Using checklists to improve care in the nonoperating room environment (2022)
  19. Time-Out Checklists Promote Safety in Nonoperating Room Anesthesia (NORA) (2021)
  20. Preoperative optimization of patients undergoing interventional procedures: infrastructure, logistics, and evidence-based medicine (2021)
  21. NORA: Considerations during COVID 19 Pandemic-The New York Experience (2021)
  22. Preventing patient positioning injuries in the nonoperating room setting (2022)

  1. Landrigan-Ossar M, Setiawan CT. Pediatric Anesthesia Outside the Operating Room: Safety and Systems. Anesthesiol Clin. 2020;38(3):577-586. doi:10.1016/j.anclin.2020.06.001

    • This article reviews system-level considerations for pediatric NORA, highlighting safety challenges such as variable locations, limited resources, and the need for standardized protocols to ensure optimal patient outcomes.

    • Link to article

  2. Setiawan CT, Landrigan-Ossar M. Practice horizons in pediatric nonoperating room anesthesia. Curr Opin Anaesthesiol. 2020;33(3):395-403. doi:10.1097/ACO.0000000000000861

    • The authors explore the expanding scope of pediatric NORA, discussing new procedural indications, evolving anesthetic techniques, and the importance of adapting practice models to meet growing demand.

    • Link to article

  3. Setiawan CT, Landrigan-Ossar M. Pediatric Anesthesia Outside the Operating Room: Case Management. Anesthesiol Clin. 2020;38(3):587-604. doi:10.1016/j.anclin.2020.06.003

    • Focusing on case-based strategies, this article provides clinical insights into managing pediatric patients in diverse non-OR environments, emphasizing preparation, monitoring, and individualized anesthetic planning.

    • Link to article

  1. Luccarelli J, Fernandez-Robles C, Fernandez-Robles C, et al. Modified Anesthesia Protocol for Electroconvulsive Therapy Permits Reduction in Aerosol-Generating Bag-Mask Ventilation during the COVID-19 Pandemic. Psychother Psychosom. 2020;89(5):314-319. doi:10.1159/000509113
    • This study presents a modified anesthesia protocol for ECT procedures during COVID-19, significantly reducing the use of bag-mask ventilation and thus minimizing aerosol generation and infection risk.
    • Link to article

  1. Bello C, Paisansathan C, Riva T, Luedi MM, Andereggen L. Anesthesia care in the interventional neuroradiology suite: an update. Curr Opin Anaesthesiol. 2022;35(4):457-464. doi:10.1097/ACO.0000000000001151

    • This review updates best practices for anesthesia in neuroradiology procedures, emphasizing airway management, neuroprotection, and workflow coordination in complex, nontraditional environments.This article outlines common IR procedures requiring anesthesia, highlighting the need for tailored anesthetic approaches, careful monitoring, and attention to logistical challenges outside the OR.

    • Link to article

  2. Chang C, Richins N. Massive Hemoptysis – A Rare but Catastrophic Complication – Anesthesia Patient Safety Foundation. August 25, 2021. Accessed June 22, 2025. https://www.apsf.org/article/massive-hemoptysis-a-rare-but-catastrophic-complication/

    • This APSF article discusses the anesthetic implications of massive hemoptysis during procedures, offering recommendations for early recognition, airway protection, and emergency preparedness.

    • Link to article

  3. Landrigan-Ossar M. Common procedures and strategies for anaesthesia in interventional radiology. Curr Opin Anaesthesiol. 2015;28(4):458-463. doi:10.1097/ACO.0000000000000208

    • This article outlines common IR procedures requiring anesthesia, highlighting the need for tailored anesthetic approaches, careful monitoring, and attention to logistical challenges outside the OR.

    • Link to article

  4. Schroeck H, Taenzer AH, Schifferdecker KE. Team factors influence emotions and stress in a non-operating room anaesthetising location. Br J Anaesth. 2021;127(3):e95-e98. doi:10.1016/j.bja.2021.06.018

    • This study shows how team dynamics significantly impact emotional stress in NORA environments, underlining the importance of communication, trust, and leadership in maintaining provider well-being.

    • Link to article

  5. Schroeck H, Welch TL, Rovner MS, Johnson HA, Schroeck FR. Anesthetic challenges and outcomes for procedures in the intraoperative magnetic resonance imaging suite: A systematic review. J Clin Anesth. 2018;54:89. doi:10.1016/J.JCLINANE.2018.10.022

    • This systematic review identifies key anesthetic challenges in the iMRI setting, such as restricted access and equipment limitations, and reports generally favorable outcomes with appropriate planning and protocols.

    • Link to article

  6. Schroeck H, Whitty MA, Hatton B, Martinez-Camblor P, Wen L, Taenzer AH. Team Relations and Role Perceptions During Anesthesia Crisis Management in Magnetic-Resonance Imaging Settings: A Mixed Methods Exploration. Jt Comm J Qual Patient Saf. 2024;50(5):308-317. doi:10.1016/j.jcjq.2024.01.007

    • This mixed-methods study explores how team relationships and unclear role definitions impact crisis response during MRI procedures, suggesting that structured training improves safety and coordination.

    • Link to article

  7. Massive Hemoptysis – A Rare but Catastrophic Complication (2021)
  8. Anesthetic challenges and outcomes for procedures in the intraoperative magnetic resonance imaging suite: A systematic review. (2018)
  9. Common procedures and strategies for anaesthesia in interventional radiology (2015)
  10. Anaesthesia clinicians’ perception of safety, workload, anxiety, and stress in a remote hybrid suite compared with the operating room (2023)

  1. Methangkool E, Urman R. What’s Next for Patient Safety in Non-OR Anesthesia? Exploring Opportunities for Teamwork. ASA Monitor. 2022;86(6):25-26.

    • This article discusses the future of patient safety in NORA by highlighting the importance of multidisciplinary teamwork, communication training, and proactive safety culture development in non-traditional procedural settings.

    • Link to article

  2. Primm AN, Schroeck H, Methangkool E, Anca D. Out of Sight, Out of Mind? A Call to Action For Leadership in Nonoperating Room Anesthesia. Anesth Analg. 2024;139(4):857-862. doi:10.1213/ANE.0000000000006856

    • The authors call for stronger institutional leadership in NORA, advocating for dedicated oversight, resources, and accountability to address systemic challenges and elevate safety standards in these rapidly expanding environments.

    • Link to article

  3. Schroeck H, Hatton B, Martinez-Camblor P, Whitty MA, Wen L, Taenzer AH. Effect of Interprofessional Crisis Simulation Training in a Non-Operating Room Anesthesia Setting on Team Coordination: A Mixed Methods Study. Jt Comm J Qual Patient Saf. 2024;51(2). doi:10.1016/j.jcjq.2024.10.009

    • This study demonstrates that interprofessional simulation-based crisis training improves team coordination and preparedness in NORA environments, emphasizing its value for enhancing patient safety and clinical outcomes.

    • Link to article

  4. Watt S, Fogarty Mac P. Utilizing Problem-Based Learning in Anesthesiology Careers – Cambridge Scholars Publishing. Cambridge Scholars Publishing; 2021. Accessed June 22, 2025. https://www.cambridgescholars.com/product/978-1-5275-6221-9

    • This book explores the integration of problem-based learning (PBL) in anesthesiology education, illustrating how PBL enhances critical thinking, team dynamics, and clinical decision-making for anesthesia professionals.

    • Link to book purchasing option

  5. What’s Next for Patient Safety in Non-OR Anesthesia? Exploring Opportunities for Teamwork (2022)
  6. Team factors influence emotions and stress in a non-operating room anaesthetising location (2021)
  7. Anesthesia Emergencies in Hybrid Operating Rooms: Multidisciplinary Crisis Resource Management (2020)

Contributors

Brianna Brunson, Idaho College of Osteopathic Medicine – Literature Review and Citation Coordinator

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