Week 6 NORA Flashcards
What is NORA?
NORA (Non-Operating Room Anesthesia) is anesthesia delivered outside of traditional operating room settings.
Where are common locations for NORA?
Common locations for NORA include radiology, endoscopy suites, MRI and CT imaging areas, and dental clinics.
What is the trend regarding NORA?
NORA is rapidly growing due to rising demand for sedation and anesthesia in remote and non-traditional settings.
What is the 3-step approach to NORA?
The 3-step approach includes: 1. The Patient, 2. The Procedure, 3. The Environment.
What does the ‘Patient’ step in NORA involve?
The ‘Patient’ step involves conducting a thorough preanesthetic evaluation, identifying the indication for sedation/anesthesia, modifying the plan for special populations, and ensuring appropriate monitoring and patient safety measures.
What does the ‘Procedure’ step in NORA involve?
The ‘Procedure’ step involves understanding procedural specifics and collaborating with procedural staff on emergency response plans and anticipated adverse events.
What does the ‘Environment’ step in NORA address?
The ‘Environment’ step addresses challenges of remote locations, ensures compliance with ASA NORA standards, and performs a complete equipment and safety check before initiating anesthesia.
What are key takeaways for NORA?
Key takeaways for NORA include expanding anesthesia practice beyond the traditional OR, a systematic 3-step approach for safety, collaboration with procedural teams, and meticulous equipment checks.
What is Office-Based Anesthesia (OBA)?
OBA is anesthesia provided in an outpatient setting not accredited as an ambulatory surgery center (ASC) or hospital.
What are unique features of OBA?
Unique features of OBA often include new patient consults, routine H&Ps, and office administration, usually in a single-specialty focus.
What are the advantages of OBA?
Advantages of OBA include lower costs, greater convenience for patients and surgeons, reduced infection risk, and greater privacy and continuity of care.
What are challenges and risks associated with OBA?
Challenges and risks include higher risk of patient injury, legal/financial concerns, and varying regulations by state.
Who are ideal candidates for OBA?
Ideal candidates for OBA are ASA I or II patients, with a strong focus on patient safety and adherence to ASA/AANA perioperative standards.
What are staffing and emergency preparedness requirements for OBA?
Requirements include a minimum of one ACLS/PALS-certified provider present until discharge, a clear emergency plan, and immediate availability of rescue medications and equipment.
What legal and business considerations should be taken into account for OBA?
Considerations include varying state regulations, consulting legal counsel for compliance, and understanding the financial/legal structure before establishing services.
What are key takeaways for OBA?
Key takeaways for OBA include benefits like cost savings and convenience, addressing patient safety and regulatory compliance, and the anesthesia provider’s role as a patient advocate.
What are the top reasons for delayed discharge from OBA?
The top reasons include postoperative nausea and vomiting (PONV) and excessive postoperative pain.
What is the difference between sedation and Monitored Anesthesia Care (MAC)?
Sedation is typically provided by non-anesthesia providers and involves moderate sedation, while MAC is delivered by anesthesia professionals and may involve deeper sedation.
What are the components of Monitored Anesthesia Care (MAC)?
MAC components include preprocedure evaluation, intraprocedure continuous presence of an anesthesia provider, and postprocedure recovery management.
What are the duties of the anesthesia provider in MAC?
Duties include administering sedatives, ensuring patient safety and comfort, monitoring vital functions, and being ready to convert to general anesthesia.
What are ASA requirements for MAC?
ASA requirements include continuous presence of a CRNA/anesthesiologist, compliance with institutional policy, and documentation and informed consent.
What are the goals of MAC?
Goals of MAC include comfort, anxiolysis, cardiorespiratory stability, optimizing surgical conditions, and avoiding patient recall.
What are pharmacologic principles of MAC?
Pharmacologic principles include titration and infusion, distribution/elimination, and context-sensitive half-time.
What are practical takeaways for MAC?
Practical takeaways include keeping sedation light for communication, monitoring for pain and anxiety, and using pharmacokinetics to guide drug selection.
