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Anesthesiol Clin. 2019 Jun;37(2):301-316. doi: 10.1016/j.anclin.2019.01.010. Epub 2019 Mar 16.

Nonoperating Room Anesthesia: Anesthesia in the Gastrointestinal Suite.

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Department of General Anesthesiology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Electronic address:
Department of General Anesthesiology, Anesthesia for Bronchoscopic Surgery, Center for Sedation, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Outcomes Research, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.


Exponential growth in endoscopy suite procedures due to technological advances requires teamwork between anesthesiologists, endoscopists, nursing teams, and technical and support staff. The current standard of care for moderate sedation includes a combination of anxiolytic drugs and analgesic drugs and sometimes are not adequate to ensure patient safety, efficiency, and comfort. The use of anesthesia services can improve safety, recovery, turnovers, and efficiency. The article discusses comprehensive preoperative evaluation, optimization of comorbidities, and intraoperative airway management strategies to deliver safe and efficient anesthesia, given the need to share the airway and allow the use of carbon dioxide in the gastrointestinal suite.


DNR; General anesthesia; MAC; NORA GI Suite; NPO

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