NORA Airway Management - Advances in medical technology
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An expanding challenge in anesthetic practice is the steady growth in cases that occur outside the OR(Operating room), what is commonly known as non-OR anesthesia (NORA). Supporting airway management is an essential piece of the puzzle of NORA. There are different modalities for airway management in the NORA setting.

It is estimated that more than 50% of NORA procedures in the United States are performed using some form of anesthesia care. NORA care presents a unique set of challenges for health care providers.

The procedures themselves are very diverse in terms of complexity, invasiveness and duration. The procedures involve a variety of medical specialties and are performed on different parts of the body.NORA procedures often involve frail and elderly patients with multiple comorbidities, such as cardiovascular conditions, pulmonary hypertension, diabetes and chronic kidney disease, obese patients with a presumptive diagnosis of obstructive sleep apnea .Gastrointestinal procedures represent the largest number of NORA cases.

NORA cases are usually performed under monitored anesthesia care (MAC) and, depending on the needs of the patient or the procedure, involve the administration of sedatives and/or anesthetics, usually by the IV route. Sedation-related adverse events are an important cause of injury and liability among NORA cases.

Providers must be ready to address airway-related complications during NORA procedures, such as airway obstruction and hypoxemia. Until recently, there were limited choices and a binary approach to airway management during NORA cases-either traditional oxygenating devices or endotracheal airway support. Considerable advances have been made, and newer and more effective modalities and devices to support the airway in NORA settings have been introduced.

Best practices for NORA procedures include thorough patient preparation and evaluation, monitoring of respiratory and hemodynamic variables, provision of anxiolysis and amnesia, comfort for the patient, and a timely and safe recovery with full ambulation. Important advances have been made in devices to support ventilation, oxygenation and instrumentation of the airway during sedation outside the OR.

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