Risks of anesthesia or sedation outside the operating room: the role of the anesthesia care provider.
OBJECTIVE
Our goal is to review the recent year's novel and relevant literature on the practice of sedation/anesthesia in the nonoperating room setting. Risk factors and outcomes were evaluated related to locations, providers, and anesthetic regimens.


RESULTS
Administration of sedation/anesthesia for patients undergoing uncomfortable or painful interventions outside the operating room is an expanding practice involving a wide variety of practitioners. With a growing emphasis on cost, efficiency, and patient satisfaction, propofol alone or in combination with other sedatives/analgesics has become popular for procedural sedation among nonanesthesiologists. Although major adverse events are rare in this setting, potentially risky complications, such as respiratory depression and desaturation, still occur and their importance cannot be neglected. In this context, the American Society of Anesthesiologists Closed Claims and the Pediatric Sedation Research Consortium databases convey some valuable data. The bulk of reported complications are related to anesthetic drug-induced respiratory depression or airway obstruction leading to hypoxemia or hypoventilation. There are several new studies highlighting the importance of capnography in detecting impending airway or respiratory adverse events.


CONCLUSIONS
The current incidence of complications associated with sedation in the nonoperating room environment remains irresolute. Although there are many studies on sedation practices in the out-of-operating room setting, high-quality studies are lacking. There are no data comparing practice outcomes between different practitioners and specialties.
Metzner
Julia
J
Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA 98195-6540, USA. metznj@u.washington.edu
Domino
Karen B
KB
D000328:Adult; D000553:Ambulatory Care; D000758:Anesthesia / Q000009:adverse effects*; D000776:Anesthesiology / Q000193:education; D002648:Child; D016292:Procedural Sedation / Q000009:adverse effects*; D003954:Diagnostic Services; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D006282:Health Personnel; D006801:Humans; D011871:Radiology; D018570:Risk Assessment; D012449:Safety; D016896:Treatment Outcome