NORA: Considerations during COVID 19 Pandemic–The New York Experience

Anca, Diana; Pua, Bradley B.; Mack, Patricia Fogarty

doi:10.1016/j.pcorm.2020.100148

Cited by 5 publications

(7 citation statements)

References 15 publications

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“…All medical staff including anesthesia team wore level 3 personal protective equipment (PPE), including liquid-proof apron, N-95 mask, goggles, visor, and overshoes, according to the ASA and Centers for Disease Control and prevention (CDC) COVID-19 protection guidelines [ 14 , 15 ]. Medical staff were then tested for COVID-19 infection via rRT-PCR 72 h after the procedure.…”

Section: Methodsmentioning

confidence: 99%

Perioperative Outcomes in COVID-19 Obstetric Patients Undergoing Spinal Anesthesia for Cesarean Section: A Prospective Observational Study

et al. 2021

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Coronavirus disease 2019 (COVID-19) adds more challenges to the perioperative management of parturients. The aim of this study is to examine perioperative adverse events and hemodynamic stability among COVID-19 positive parturients undergoing spinal anesthesia. This prospective observational investigation was conducted at a tertiary teaching hospital in Jordan between January and June 2021, during which 31 COVID-19 positive parturients were identified. Each COVID-19 positive parturient was matched with a COVID-19 negative parturient who received anesthesia under similar operating conditions as a control group. Of the 31 COVID-19 patients, 22 (71%) were otherwise medically free, 8 (25.8%) were emergency cesarean sections. The sensory level of spinal block after 10 min was T8 (T6–T10) among COVID-19 positive group, compared to T4 (T4–T6) among control group (p = 0.001). There were no significant differences in heart rate, SBP, DBP, and MAP intraoperatively (p > 0.05). Twelve (36.4%) neonates born to COVID-19 positive patients were admitted to NICU, compared to four (11.8%) among control group (p = 0.018). There was no statistically significant difference in postoperative complications. In conclusion, spinal anesthesia is considered a safe anesthetic technique in COVID-19 parturients, and therefore it is the anesthetic method of choice for cesarean deliveries among COVID-19 patients.

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Section: Methodsmentioning

confidence: 99%

Perioperative Outcomes in COVID-19 Obstetric Patients Undergoing Spinal Anesthesia for Cesarean Section: A Prospective Observational Study

et al. 2021

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“…Due to the nature of the airborne and gastrointestinal transmission of the virus, bronchoscopy and GI procedures were the most impacted, since the American Gastroenterological Society, American College of Chest Physicians and American Association for Bronchology and Interventional Pulmonology all published guidelines drastically limiting aerosol-generating elective procedures during the worst months of the pandemic [38,39]. By contrast, the minimally invasive nature of the IR suite and catheterization laboratory proved to be beneficial in treating acute conditions concomitant with COVID-19 infection while also protecting providers [40]. Whether or not a similar outbreak occurs in the future, health systems providing NORA procedures will likely apply lessons in infection control to their future system designs.…”

Section: Effect Of Coronavirus Disease 2019 On Nonoperating Room Anes...mentioning

confidence: 99%

National trends in nonoperating room anesthesia: procedures, facilities, and patient characteristics

Du¹,

Robbins

Waterman

et al. 2021

Current Opinion in Anaesthesiology

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Purpose of reviewNonoperating room anesthesia (NORA) continues to increase in popularity and scope. This article reviews current and new trends in NORA, trends in anesthesia management in nonoperating room settings, and the evolving debates surrounding these trends. Recent findingsNational data suggests that NORA cases will continue to rise relative to operating room (OR) anesthesia and there will continue to be a shift towards performing more interventional procedures outside of the OR. These trends have important implications for the safety of interventional procedures as they become increasingly more complex and patients continue to be older and more frail. In order for anesthesia providers and proceduralists to be prepared for this future, rigorous standards must be set for safe anesthetic care outside of the OR. Although the overall association between NORA and patient morbidity and mortality remains unclear, focused studies point toward trends specific to each non-OR procedure type. Given increasing patient and procedure complexity, anesthesiology teams may see a larger role in the interventional suite. However, the ideal setting and placement of anesthesia staff for interventional procedures remain controversial. Also, the impact of COVID-19 on the growth and utilization of non-OR anesthesia remains unclear, and it remains to be seen how the pandemic will influence the delivery of NORA procedures in postpandemic settings. SummaryNORA is a rapidly growing field of anesthesia. Continuing discussions of complication rates and mortality in different subspecialty areas will determine the need for anesthesia care and quality improvement efforts in each setting. As new noninvasive procedures are developed, new data will continue to shape debates surrounding anesthesia care outside of the operating room.

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“…This is especially true with regard to pediatric NORA where medication errors may be more likely because of the need to perform further dilutions [34 ▪▪ ]. Silver linings of the COVID pandemic were greater collaboration and communication among NORA team members, ensuring all necessary medications and supplies were present prior to beginning a procedure and an improved overall culture of safety [35 ▪▪ ]. Extending this collaboration to include enhanced communication both within the anesthesia team as well as among nursing and proceduralists is essential to advance medication safety.…”

Section: Communicationmentioning

confidence: 99%

Medication safety in nonoperating room anesthesiology

Mack¹

2021

Current Opinion in Anaesthesiology

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Purpose of reviewMedication errors remain a prominent source of medical harm in spite of over 20 years of effort in establishing standardized protocols and procedures, implementing assistive electronic technologies to identify medications and prevent administration errors and in establishing a just culture with regard to reporting events and near misses. Recent findingsSome of these interventions are even more necessary in the nonstandard environment of a non-operating room anesthesiology (NORA) procedure suite, where the anesthesiologist is often far removed from colleagues, in a dark room, lacking the standard medications commonly found in their operating room. Medication availability in NORA sites may be limited because of lack of standardization or distance from the operating room pharmacy. Proper preparation of medication may be impaired by poor lighting and cramped conditions. Medication administration might be hampered by a lack of infusion pumps or pumps without the proper medication library needed by the anesthesiologist.

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NORA: Considerations during COVID 19 Pandemic–The New York Experience

Cited by 5 publications

References 15 publications

Perioperative Outcomes in COVID-19 Obstetric Patients Undergoing Spinal Anesthesia for Cesarean Section: A Prospective Observational Study

Perioperative Outcomes in COVID-19 Obstetric Patients Undergoing Spinal Anesthesia for Cesarean Section: A Prospective Observational Study

National trends in nonoperating room anesthesia: procedures, facilities, and patient characteristics

Medication safety in nonoperating room anesthesiology

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