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This is a sidebar to a story on safety concerns with the growing use of anesthesia care outside the operating room.

Including anesthesia teams in the design of procedural suites outside of the operating room could be one way to help improve patient safety, experts said.

Currently, the majority of procedural suites were built based on the needs of the specialists, not the anesthesiologists, said Emily Methangkool, MD, MPH, vice chair of quality and patient safety at the University of California Los Angeles.

"The rooms that [cases] are being done in were not designed to have anesthesia," said Jeffrey White, MD, an associate professor of anesthesiology at the University of Florida. "Anesthesia is an afterthought."

Instead, the suites were designed for optimal placement of the interventional equipment, the CT scanner or MRI machine, but little consideration was given to where an anesthesia machine or equipment might be placed for a procedure, Methangkool said.

"At that time, when they were building the hospital, they didn't necessarily need an anesthesia machine because we weren't providing anesthesia services in those areas," Methangkool said. "So we have had to retrofit our equipment into the locations that already exist."

Some anesthesia-specific considerations include where to place lines for oxygen and other gasses, Methangkool said. Another thing to consider would be location of various specialty procedural suites so that anesthesiologists don't have to dash all over the hospital to get from interventional cardiology to gastroenterology, for example.

Mladen Vidovich, MD, of University of Illinois Health, who is board-certified in both cardiology and anesthesiology -- which he says gives him a unique perspective on this issue -- agreed that room layout and logistics for anesthesia providers is not ideal.

"It's actually quite difficult for the anesthesiologists, I know from my perspective being on the other side," Vidovich told MedPage Today. He added that anesthesiologists don't always have immediate access to a patient's airway, for example.

He also highlighted the issue of patient recovery location, which is standardized in the OR, but not all cath labs, for instance, have a recovery room. This can complicate non-OR anesthesia (NORA) cases for anesthesia providers by adding additional considerations that diverge from standard OR practices.

Some of these concerns are being addressed as new facilities are being built for gastroenterology, interventional cardiology, and interventional radiology. Both White and Methangkool acknowledged that anesthesiologists are having a much larger role in the design of these new procedural suites. Methangkool said several factors that affect patient safety can be addressed when anesthesia providers are consulted early in the development of these suites.

"They will generally have sufficient accommodations," Vidovich said. "There's going to be enough space for the anesthesia machine as well because sometimes if you cram in the anesthesia machine in the small cath lab, it may not work."

Anesthesiologists are hoping that updating these spaces can lead to more consistent and predictable anesthesia services for patients. But those changes need to be made intentionally, Methangkool said.

"Now going forward, whenever a new NORA location is being built, it's very important for an anesthesiologist or anesthesia team to be at the table to kind of dictate the safest way where to place the anesthesia machine and the anesthesia equipment," she said. "Going forward, I think people recognize that that is a need. But for many hospitals that aren't building new locations and have to retrofit these areas, it's a significant problem."

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