# Respiratory Depression in Non-Operating Room Anesthesia: An Overview

## TL;DR

This paper discusses how respiratory issues are a major risk in non-operating room anesthesia, especially under monitored sedation, and highlights safety standards and research needs.

## Contribution

The paper provides an overview of respiratory depression risks in non-operating room anesthesia and emphasizes the role of monitoring and patient factors.

## Key findings

- Respiratory depression is the leading cause of complications in non-operating room anesthesia.
- Most claims involve oversedation and inadequate monitoring during monitored anesthesia care.
- ASA standards and recommendations aim to improve safety in non-operating room settings.

## Abstract

Non-operating room anesthesia (NORA) is a rapidly growing domain for anesthesia professionals due to advances in procedural technology and increased emphasis on patient comfort. The majority of these procedures are conducted under monitored anesthesia care (MAC) where patients receive varying levels of sedation. Analysis of the Anesthesia Closed Claims database suggests that adverse respiratory events continue to be the main cause of morbidity and mortality in patients undergoing NORA procedures. Most NORA claims occurred under MAC, with oversedation leading to respiratory depression coupled with inadequate monitoring making up the majority of claims. The American Society of Anesthesiologists (ASA) has released standards of pre-anesthesia, intraoperative monitoring, and post-anesthesia care, which apply to all anesthetizing locations including NORA. The ASA has also made recommendations in a statement on NORA to promote patient safety. Evidence suggests that patient characteristics, monitoring tools, physical constraints, and team familiarity play a role in the risk for adverse respiratory events. Future studies are required to further understand the challenges specific to NORA locations.