Our Approach to Non-Operating Room Anesthesia
Montefiore Einstein Non-Operating Room Anesthesiology (NORA) provides state-of-the-art, individualized procedural anesthesia care for patients of all ages undergoing complex diagnostic and minimally invasive interventional procedures outside the traditional operating room (OR).
As procedural medicine advances, Montefiore Einstein NORA brings operating room–level monitoring, physiologic management and safety standards to remote procedural environments. Our team is specially trained in advanced airway management, hemodynamic optimization and real-time monitoring in high-acuity settings. From pediatric patients requiring imaging sedation to elderly patients with significant cardiovascular disease undergoing complex interventions, we provide precise and reliable anesthetic care throughout the periprocedural period.
For patients with cancer, we collaborate closely with Montefiore Einstein Comprehensive Cancer Center, which is among the elite 1% of NCI-designated comprehensive cancer centers in the United States, and we are ranked in the top 1% of all U.S. hospitals for cancer care, cardiology, neurology and neurosurgery, and pediatric cancer according to U.S. News & World Report.
Multidisciplinary Collaboration
Multidisciplinary collaboration is a cornerstone of our success. Together with our medical and Our anesthesiologists partner with specialists in interventional cardiology, electrophysiology, interventional radiology, neurointerventional surgery, diagnostic radiology, radiation oncology, pediatric gastroenterology and pulmonology to deliver coordinated and individualized care. We also work closely with referring physicians to ensure timely access to diagnostic imaging and procedural services requiring anesthesia.
Advanced Treatments
Montefiore Einstein NORA provides anesthesia services for nearly 6,000 procedures annually, supporting some of our most advanced diagnostic and interventional programs.
We provide the most advanced anesthesiology techniques and technologies to deliver the highest quality of care for our patients. Our team offers the full range of anesthetic services for non-OR procedures, including minimal, moderate or deep sedation, as well as monitored anesthesia care (MAC), regional anesthesia and general anesthesia. Prior to the procedure, our anesthesia providers determine the anesthetic care most appropriate for the individual patient based on their medical conditions and treatment plan.
Our anesthesia providers use leading-edge technology and airway equipment to deliver the best possible care for our patients. We continually implement new, innovative techniques to improve our patients’ experiences in our procedural suites. We provide the latest evidence-based and individualized care to ensure safe, effective and compassionate care for our patients undergoing procedures in some of the following areas:
- Cardiac catheterization procedures and structural heart interventions, including transcatheter aortic valve replacement (TAVR) and MitraClip™
- Transesophageal echocardiography (TEE), including anesthesiologist-performed TEE guidance for structural heart and electrophysiology procedures
- Electrophysiology procedures, including complex ablations and left atrial appendage occlusion (WATCHMAN)
- Interventional radiology and acute stroke thrombectomy
- Magnetic resonance imaging (MRI) and computed tomography (CT) imaging for patients unable to tolerate procedures due to age, claustrophobia or behavioral challenges
- Radiation oncology treatments requiring immobility
Our coverage model integrates expertise from pediatric, cardiac and neuroanesthesiology, matching subspecialty knowledge to procedural complexity. Residents and subspecialty fellows participate in care as part of their advanced training, ensuring excellence in both clinical delivery and education. This structure maintains subspecialty-level expertise while promoting efficiency and continuity across multiple procedural locations.
Research
Montefiore Einstein NORA collaborates with the Digital Health Laboratory to conduct outcomes research focused on optimizing sedation and anesthesia delivery in procedural settings. Current initiatives aim to identify which patients benefit most from anesthesiologist-led sedation and which may be safely managed by procedural teams.
Through data-driven analytics and interdisciplinary collaboration, we are committed to refining patient selection, improving efficiency and supporting the ongoing evolution of minimally invasive and image-guided therapies.
Performance Improvement
We are committed to optimizing patient care, prioritizing patient safety and preventing complications. Montefiore Einstein NORA works closely with Anesthesiology Critical Care Medicine to provide anesthesia support services for any emergent situations that may arise during procedural sedation. We are continually working with our proceduralist colleagues to enhance our safety criteria for non-anesthesia procedural sedation and to implement early-warning recognition through the use of end-tidal carbon dioxide (ETCO2) monitoring.
Non-Operating Room Anesthesiology Education & Training
At Montefiore Einstein Anesthesiology, we are committed to training the next generation of anesthesiologists, both in the operating room and in a variety of procedural suites. Residents and fellows receive extensive clinical and research opportunities, structured didactics, mentorship and broad exposure to NORA cases. Our Anesthesiology faculty closely guides our residents and fellows to ensure our trainees learn the most advanced NORA techniques. Our goal is to foster the careers of our trainees and prepare them for modern anesthesia practice in any setting.
Your Non-Operating Room Anesthesia Team
Daniel O. Thomas-Rueddel, MD
Led by Daniel Thomas-Rueddel, MD, Chief of NORA, our team of board certified anesthesiologists and certified registered nurse anesthetists (CRNAs) collaborates closely with specialists from the Departments of Surgery, Medicine and Radiology, among others, to enhance patient safety for patients undergoing non-OR procedures. Together, we develop comprehensive and personalized treatment plans to ensure the best care is provided throughout the periprocedural period.
