Anesthesiology Oversight for Procedural Sedation

Driven by advances in minimally invasive diagnostic and therapeutic procedures, the demand for anesthesia and procedural sedation outside the OR has expanded more rapidly than ever. This has placed tremendous strain on anesthesiology departments, both to fulfill anesthesia service needs and to oversee procedural sedation. Nonoperating room anesthesia (NORA) is an extension of OR anesthesiology practice, either personally performed, medically directed, or nonmedically directed. Separate from the extension of anesthesiology services to NORA settings is the procedural sedation performed by nonanesthesiologist providers in many procedural units. Because of the significant variability that may exist in sedation practices (e.g., patient preparation and monitoring, practitioner education and training, oversight of quality and safety in provided care), procedural sedation may place patients, practitioners, and health systems at risk. Whether or not the anesthesiology department fully embraces the role, physician anesthesiologists are responsible for patient safety and regulatory compliance everywhere procedural sedation is performed....