Maddirala Subrahmanyam, Theagrajan Annu
Department of Anaesthesiology, Rainbow Children's Hospital, Hyderabad, Telangana, India.
Director, Axon Anaesthesia Associates Pvt. Ltd., Hyderabad, Telangana, India.
Indian J Anaesth. 2019 Sep;63(9):754-762. doi: 10.4103/ija.IJA_486_19.
Administration of sedation and/or anaesthesia to patients undergoing painful or uncomfortable procedures at off-site locations is referred to as non-operating room anaesthesia (NORA). Sedating/anaesthetising children in an unfamiliar environment, with the lack of support staff, nonavailability of choice of medication and equipment is often challenging. Studies have shown an increased risk of airway-related adverse events, complications, and even death outside the operating room locations. It is crucial to be familiar with the anatomical and physiological variations in children, well versed with the difficult airway algorithm and call for help early. The most common event in NORA claims was inadequate oxygenation/ventilation, which are preventable with vigilant monitoring. English language articles were searched in Pubmed, Google Scholar, and Academic using 'sedation in children', 'remote location anaesthesia', 'peadiatric sedation', and 'nonoperating room anaesthesia' as the mesh words. Full text of the relevant articles was obtained and this review article was synthesised. The article outlines various safety guidelines, sedation techniques, drugs used for sedation, environmental concerns, procedure-specific risks, and complications associated with NORA in children.
在非手术室地点对接受疼痛或不适操作的患者实施镇静和/或麻醉被称为非手术室麻醉(NORA)。在不熟悉的环境中对儿童进行镇静/麻醉,由于缺乏辅助人员、没有药物和设备可供选择,往往具有挑战性。研究表明,在手术室以外的地点发生气道相关不良事件、并发症甚至死亡的风险增加。熟悉儿童的解剖和生理差异、精通困难气道处理流程并尽早呼救至关重要。NORA索赔中最常见的事件是氧合/通气不足,通过 vigilant 监测是可以预防的。使用 “儿童镇静”、“远程麻醉”、“儿科镇静” 和 “非手术室麻醉” 作为关键词,在 Pubmed、谷歌学术和学术数据库中检索英文文章。获取了相关文章的全文并撰写了这篇综述文章。本文概述了各种安全指南、镇静技术、用于镇静的药物、环境问题、特定操作的风险以及与儿童NORA相关的并发症。