The number of diagnostic and surgical procedures being performed outside the core operating area is growing disproportionately. Due to the higher perioperative risk for such patients, anesthesia should only be provided by a very experienced anesthesiologist, even for supposedly small interventions. At these locations, timely and direct access to the anesthesia machine and/or the patient is often limited and if additional personnel or supplies are required, substantial time delays usually occur and should be allowed for. Standard operating procedures that are optimized to local requirements and providing a specially equipped anesthesia trolley for diagnostic and surgical procedures outside of the core operating area, may decrease the likelihood of complications induced by poorly equipped anesthesia workplaces. For electroconvulsive therapy (ECT), the standard drugs are methohexital in combination with short-acting opioids, such as remifentanil and succinylcholine. Significant variations in arterial blood pressure and heart rate are possible. Anesthesia induction in children with a known difficult airway or difficult intravascular access should initially be performed in a location with optimal infrastructure with subsequent transfer to the diagnostic or surgical suite outside the core operating area. Before entering the magnetic resonance imaging (MRI) suite, personal ferromagnetic items (e.g. pens, credit cards, stethoscopes, keys, telephones, USB sticks) should be removed to prevent injury and data loss; a MRI-compatible anesthesia machine and equipment is compulsory. Patients with cardiac pacemakers, cochlea implants, aneurysm or other clips, metallic-based tattoos or make-up are not normally compatible with MRI. General anesthesia should be preferred over conscious sedation for magnetic resonance imaging and ear protection is necessary for anesthetized patients. Gastroscopy in children should be performed under general anesthesia; and when concluding the procedure, air insufflated into the gastrointestinal tract should be suctioned in all patients. For angiography, maximum monitoring needs to be available to provide hemodynamically unstable patients with adequate anesthesia care; comprehensive radiation protection for patients and staff as well as temperature monitoring for prolonged diagnostic procedures is also necessary. Monitoring oxygen saturation and end-tidal carbon dioxide as well as employing visual and audible alarms is an essential requirement even during conscious sedation. In summary, the number of diagnostic and surgical procedures performed outside the core operating area should be reduced to a minimum and, whenever possible, diagnostic or surgical procedures should be performed within the core operating area.
