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Dream Journal

NORA: New Regulations

Updated: Jul 19

Audrey Patterson



Anesthesia is a term used in medicine when referring to the practice of using medical drugs to reduce pain and/or dull a patient’s senses during surgery. This is a very necessary

process as having a patient react to the pain from a surgery being performed could cause

complications during the surgery and it would be incredibly uncomfortable for most

patients. Anesthesia is usually used in the operating room but there are cases of anesthetics

being used outside the operating room for things such as in transesophageal

echocardiography (a medical test where sound waves are used to take pictures of the heart),

during a patient’s recovery, and many more. These cases involve non-operating room

anesthesia (NORA). While most current cases of anesthetic use are in a hospital and

usually in an operating room, NORA cases are projected to exceed 50% of total anesthesia

cases in the near future. The Anesthesia Patient Safety Foundation recently did a review of

resources that have been available when anesthesia was used outside the operating room.

Following this review, a list of regulations for methods, staffing, equipment, procedural

care, and patient selection for cases.

The big issues regarding NORA include that outside the operating room, there is an increased distance from normal equipment used in anesthesia, most providers who work

regularly with anesthetics work in the operating room, and there could be communication

issues within a hospital regarding the care of a patient who didn’t come from the operating

room but still required the usage of anesthetics. The article linked below details the new

NORA regulations created by the Anesthesia Patient Safety Foundation address the

safe conduct of non-operating room anesthesia. These regulations mostly focus on who can

use anesthesia outside the operating room such as what their qualifications have to be, who

can be a patient in a NORA case, and what equipment must be present and in working

order within the facility. These new regulations should help protect patients from receiving

a lower standard of care and ensure safety procedures are followed properly.


References:

  1. Beard J, Methangkool E, Angus S, Urman RD, Cole DJ. Consensus Recommendations for the Safe Conduct of Nonoperating Room Anesthesia: A Meeting Report From the 2022 Stoelting Conference of the Anesthesia Patient Safety Foundation. Anesth Analg. 2023;137(2):e8-e11. doi:10.1213/ANE.0000000000006539

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