Risk and safety of anesthesia outside the operating room.

More and more frequently anaesthetists must be able to provide complete, integrated anaesthetic care outside the traditional environment of the operating room. Providing non-operating room anaesthesia (NORA) has gained widespread popularity. Both the number and the complexity of these therapeutic and diagnostic procedures is increasing. Performing NORA cannot, in most cases, be compared with traditional anaesthesia care inside the operating room. NORA might carry a higher risk as opposed to anaesthesia inside the operating room. It has its specific logistical problems resulting in specific patient selection, pre-operative patient assessment, per-operative morbidity and mortality and post-operative patient follow-up and treatment. From what is available in the literature paediatric patients carry a high risk of complications; monitored anaesthesia care is associated with more complications and substandard care is often present. Despite these potential risks, the mortality and morbidity related to NORA is infrequently studied and poorly described. Most authors agree that improvements in monitoring are essential to decrease the complication rate.