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Non-Operating Room Anesthesia

Non-operating room anesthesia involves the administration of anesthesia outside the operating theatre for patients undergoing uncomfortable or painful procedures. The procedures requiring non-operating room anesthesia include esophagogastroduodenoscopy (EGD), endoscopic retrograde cholangiopancreatography (ERCP), endobronchial ultrasound with transbronchial needle aspiration, bronchoalveolar lavages, balloon bronchoplasty, percutaneous transcatheter aortic valve replacement, percutaneous coronary intervention, radiological imaging, and in-vitro fertilization retrieval.

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  • Radiology: Anesthesia during the radiological procedures is important to overcome several challenges, such as altered sensation, claustrophobia (fear of confined or enclosed spaces), the inability to remain still during the procedure, and a lack of cooperation. Certain radiological procedures may result in anxiety, pain, and psychological and physical distress. Some radiological procedures requiring anesthesia include magnetic resonance imaging (MRI), computed tomography (CT), nuclear medicine, and interventional radiology.
  • Cardiology: Several procedures in the catheterization lab require the services of anesthesiologists. The patients during the procedure may be under sedation or anesthesia. Patients undergoing percutaneous interventions require anesthesia when they experience hemodynamic instability or respiratory depression due to an acute myocardial infarction. Procedures requiring anesthesia include percutaneous septal defect closure, cardioverter defibrillator implantation, Transcatheter cardiac valve stenting, electrophysiological studies, and pediatric cardiac interventions.
  • Medical Gastroenterology:Anesthesia may also be required in patients undergoing gastrointestinal endoscopy and colonoscopy procedures. Anesthesia during these procedures helps prevent anxiety, improves endoscopic performance, manage pain, and provide amnesia (the loss of memories related to facts and information during the procedure).
  • Radiation Oncology: Radiation therapy is a painless procedure, and most patients complete their treatment without sedation or anesthesia. Emotional support from family and the potential reward of a disease-free life motivates patients to complete the treatment successfully without anesthesia. However, oncologists may recommend anesthesia in certain cases, such as children, the presence of anxiety, or emotional immaturity, the complexity of the treatment (such as receiving radiation therapy in a prone position), and a history of noncompliance to instructions of radiologists.

Faq's

How is the child's recovery after anesthesia during the radiological examination?

The child is shifted to the recovery room after the radiological procedure. The nurse constantly monitors the vital parameters of the child until the effect of anesthesia is completely weaned off. The child may experience tiredness and emotional stress after waking up.The effect of anesthesia may be completely weaned off within one hour. The child is given liquids, such as juice, and should be kept awake. Once the child can stay awake and gather full consciousness, the doctor may discharge him or her from the hospital.

What is the difference between delivering anesthesia in the medical gastroenterology domain and other subspecialties?

Delivering anesthesia during gastrointestinal diagnostic procedures is unique compared to other subspecialties. The depth of sedation is generally similar to general anesthesia, but the airways remain unprotected. The management of complications during anesthesia depends upon the procedures used. For example, in the case of upper GI endoscopy, spontaneous ventilation is preserved, and cough reflexes are suppressed, while gag reflex preservation is important during colonoscopy. Further, preoxygenation may be provided during endoscopic retrograde cholangiopancreatography (ERCP).