LAUSR

DOI:10.1097/ACO.0000000000000524 ‘As the last century belonged to invasive surgery, the next century will belong to interventionalists’, one author writes. Diagnostic and therapeutic procedures in the nonoperating room anesthesia (NORA) suites have expanded rapidly. Considered as the most swiftly growing area in anesthetic caseload (at least half of NORA cases now need anesthesia), organization difficulty lingers. Advanced nonoperating room procedures have the potential to replace invasive surgical operations. Older and frailer patients continue to benefit from the tolerability and faster recovery offered by less invasive procedures. Evident of its increasing importance, the American Board of Anesthesiology (ABA) has now made NORA clinical training mandatory to the curriculum for anesthesia residents, covering NORA materials in in-training examinations. With the introduction of cancer surveillance programs, imaging techniques to detect early cancer and submucosal resection of malignant lesions, that would have been treated surgically, have also developed. In the bronchoscopy suite, diagnostic and therapeutic approaches such as endobronchial ultrasound (EBUS), endobronchial imaging of peripheral lung nodules, and transbronchial needle aspiration of mediastinal or hilar lymph nodes, revolutionized the staging of lung cancer. Nonoperating room anesthesia locations have unique challenges. Despite increasing demand for anesthesia support from NORA locations, efficient staffing of multiple locations (resulting in underutilization) remains a major problem. To many anesthesia providers, NORA is perceived as ‘uncomfortable and risky’. Nonanesthesia personnel in these facilities are not familiar with standard safety of anesthesia delivery. Anesthesia equipments are often transported to NORA locations; critically ill patients are likewise transported to and from these sites. Although new interventional techniques constantly develop, the need for additional resources equipment or personnel-wise, is conceivably a perpetual undertaking. As many procedural cases are