Preoperative considerations for nonoperating room anesthesia

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: Not reported — narrative review without quantitative synthesis

• Primary Outcome: Synthesis of best-practice recommendations for preoperative evaluation, patient selection, and risk stratification in NORA settings

• Nnt Or Sensitivity: Not reported; STOP-Bang questionnaire sensitivity/specificity for OSA screening and FRAIL scale diagnostic performance are referenced qualitatively but not quantitatively synthesised within this review

• Confidence Interval: Not reported

Clinical Application

Implementation of structured NORA preoperative protocols is feasible in well-resourced tertiary centres. Adoption of STOP-Bang and FRAIL screening tools requires minimal additional resources and can be integrated into existing pre-admission workflows. Telemedicine integration requires infrastructure investment and digital health literacy among patients and staff. Multidisciplinary collaboration models may face workforce and scheduling constraints in smaller facilities. NORA volumes are increasing substantially across Australian hospitals, driven by growth in endoscopy, interventional cardiology, and interventional radiology. The Australian and New Zealand College of Anaesthetists (ANZCA) Professional Document PS55 (Guidelines for the Perioperative Care of Patients with Suspected or Confirmed Obstructive Sleep Apnoea) supports STOP-Bang use in preoperative screening. FRAIL scale is not formally embedded in RACGP or ANZCA preoperative guidelines but aligns with the RACGP's emphasis on frailty assessment in older patients. Telemedicine preoperative assessment has been accelerated post-COVID-19 in Australian practice, with MBS telehealth item numbers supporting remote consultations. PBS implications are indirect — optimisation of comorbidities (e.g., CPAP for OSA, antihypertensives) prior to NORA procedures aligns with existing PBS-subsidised therapies. TGA-approved monitoring equipment requirements for NORA locations are governed by ANZCA PS55 and the Australian Commission on Safety and Quality in Health Care standards. Adult patients scheduled for procedures in NORA locations including endoscopy suites, interventional radiology, cardiac catheterisation laboratories, radiation oncology, and other remote procedural areas; particularly relevant for elderly patients and those with significant comorbidities including obesity, obstructive sleep apnoea, frailty, and cardiovascular disease

Abstract

PURPOSE OF THE REVIEW: This review aims to address the unique challenges in nonoperating room anesthesia (NORA) locations, emphasizing the importance of patient selection, risk stratification, and comprehensive preoperative evaluation to ensure safe anesthetic care for increasingly complex patients. RECENT FINDINGS: The volume of NORA procedures has risen significantly, with patients often presenting higher comorbidity burdens and advanced age. Standardized protocols and validated assessment tools, such as the STOP-Bang questionnaire and a simple frailty questionnaire (e.g., FRAIL), can aid anesthesiologists in effectively stratifying risk and tailoring anesthesia plans. Challenges in NORA include logistical constraints, personnel dynamics, and environmental factors that can compromise patient safety. The integration of telemedicine and artificial intelligence into preoperative assessments shows promise in improving efficiency and safety by allowing for remote evaluations and tailored care. SUMMARY: Adequate patient selection and preoperative optimization are essential for enhancing outcomes in NORA locations. Adherence to national safety guidelines and multidisciplinary collaboration is crucial for navigating the complexities of remote anesthesia care. Future research should focus on refining preoperative screening methods and utilizing artificial intelligence to better address the unique needs of patients undergoing procedures outside traditional operating rooms.

References

1. 1.Villa, J. F., Ramirez, M. F., & Hepner, D. L. (2026). Preoperative considerations for nonoperating room anesthesia. Current Opinion in Anaesthesiology. https://doi.org/10.1097/ACO.0000000000001674