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  1. When providing anesthesia at offsite locations, one should ensure adequate staff trained to assist the anesthesia provider, and a means to request further assistance when needed.

  2. During all anesthetics, the patient’s oxygenation, ventilation, circulation, and temperature (when clinically significant changes are expected) shall be continuously monitored.

  3. The anesthetic plan will vary depending upon patient characteristics, past medical history, and the type of procedure or imaging modality. Commonly used anesthetics in offsite locations with no scavenging system include propofol, dexmedetomidine, benzodiazepines, ketamine, and opioids.

  4. The length of stay following a procedure will be based upon the surgical procedure and/or imaging exam, as well as patient and anesthetic variables.

  5. Providing anesthesia in the magnetic resonance imaging (MRI) area has unique challenges, due to the high magnetic field. MRI-compatible equipment is required, and the anesthesiologist assumes greater physical distance from anesthetized patients.

  6. The shorter nature of most computed tomography (CT) scans, some of which do not require intravenous access, allow for variable anesthetic techniques.

  7. Children may require anesthesia for general fluoroscopy, nuclear medicine, radiation therapy, and MEG (magnetoencephalography) scans, despite the usually non-painful nature of these imaging modalities. A short-acting anesthetic such as propofol and dexmedetomidine can provide adequate conditions for successful images.

  8. Procedures in the interventional radiology suite can be both simple and complex, and patients can have significant comorbidities. The anesthesia provider anesthetizing in this area should be flexible, communicate well, and expect the unexpected.

The topic of “Offsite Anesthesia” or “Non-Operating Room Anesthesia” (NORA) is becoming increasingly common in the pediatric anesthesiology world. With the rising number of imaging modalities and non-invasive procedures being performed outside of the traditional operating room, anesthesiologists will be increasingly asked to provide care to pediatric patients—often times, in unfamiliar locales. Providing safe care is of top priority, and requires an in-depth knowledge of the patient, procedure, and an understanding of the logistics and limitations of the location itself.


Children or infants may require procedures and imaging exams at sites outside of the usual operating room environment. Imaging exams on non-movable equipment (MRI and CT), rare disease processes that require specialized treatment (radiation therapy) or providers with subspecialty skills and procedures requiring specialized equipment (interventional radiology), will require a traveling anesthesia provider. A qualified provider who is comfortable with being uncomfortable is ideal, as problems not typically experienced in the familiar operating room setting are likely. This traveling provider must pay the utmost attention to details, preferably have a good rapport with team members, and be prepared for adverse events which will inevitably occur.

Preoperative Evaluation

The ability to provide safe anesthetic care to a child begins with a thorough preoperative evaluation and a clear understanding of the patient’s disease. This includes, in particular, assessment of the patient’s airway, respiratory, and cardiovascular systems. A note from the referring physician is helpful in ascertaining ...

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