Anesthesia and sedation outside the operating room: how to prevent risk and maintain good quality

PURPOSE OF REVIEW: The purpose of this review is to define risks for anesthesia and sedation outside the operating room, and to suggest how to prevent these risks and maintain quality of care. RECENT FINDINGS: There are no recent data on risk for anesthesia outside the operating room, except information derived from the American Society of Anesthesia Closed Claims project, which indicates there is a higher risk for office-based anesthesia. SUMMARY: Complications of anesthesia outside the operating room are not well studied, although a few closed claims are appearing in the literature suggesting there is a higher risk. Topics discussed focus on MRI and surgical procedures, principally dental, plastic, and gastrointestinal endoscopy. Risk factors for these procedures are identified and quantified and measures to reduce them discussed, with emphasis on full oxygenation and end-tidal carbon dioxide monitoring. Nonoperating room anesthesia requires skills, experience and organization. Quality can only be assured by ensuring all alternative locations adhere to operating room standards.