Our Approach to Non-Operating Room Anesthesia
The Montefiore Einstein Non-Operating Room Anesthesia (NORA) Division provides state-of-the-art periprocedural anesthesia care for patients undergoing a range of procedures performed outside of operating rooms (ORs). Our expert team of anesthesiologists and certified registered nurse anesthetists (CRNAs) collaborates closely with nursing colleagues and specialists from the Departments of Surgery, Medicine and Radiology, among others, to offer comprehensive care throughout the periprocedural periods. Performing more than 23,000 NORA procedures annually, our team has expertise in managing both adult and pediatric patients with complex conditions in non-OR settings, prioritizing safety and ensuring the highest levels of comfort at every stage of the process. Using the latest technologies and anesthesia techniques, we are dedicated to delivering the highest quality care tailored to each patient’s unique needs. Montefiore Einstein is ranked in the top 1% of all hospitals in the nation for complex specialty care according to U.S. News & World Report.
Multidisciplinary Collaboration
Multidisciplinary collaboration is a cornerstone of our success. Together with our medical and surgical colleagues, our anesthesia providers assess each patient prior to their procedure to determine the best course of action for their anesthesia care. We then monitor patients during and after their procedure, working together with our nursing colleagues and communicating with all members of the patient’s care team. Montefiore Einstein NORA actively participates in multidisciplinary education and quality assurance initiatives to maximize efficiency and enhance patient safety.
Advanced Treatments
We offer access to the most advanced anesthesiology techniques and technologies to provide 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 personalized care to ensure safe, effective and compassionate care for our patients undergoing procedures in some of the following areas:
- Bronchoscopy suite
- Cardiac catheterization lab
- Computed tomography (CT) suite
- Electroconvulsive therapy
- Electrophysiology lab
- Gastrointestinal endoscopy suite
- Interventional radiology
- Interventional pulmonology
- Interventional vascular
- Neuro-interventional
- Magnetic resonance imaging (MRI) suite
- Nuclear medicine
- Pain management procedure rooms
- Pediatric cardiac catheterization
Research
We are leading collaborative research in clinical operations and patient safety, specifically as it pertains to NORA procedures. Researchers in our Digital Health Laboratory have conducted several observational studies showing that having an anesthesia provider administer sedation for patients undergoing procedures in non-OR settings improves patient outcomes. We completed the first retrospective cohort study analyzing the impact of anesthesiologist-led sedation on patients undergoing interventional radiology and endoscopic procedures. The study, which included data from more than 22,800 patients at Montefiore Einstein, found that those who received sedation performed by an anesthesia provider had a 44% lower risk of non-home discharge.
Performance Improvement
We are committed to optimizing patient care, prioritizing patient safety and preventing complications. As such, our NORA Division 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 (CO2) 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
Sujatha Ramachandran, MD
Led by Sujatha Ramachandran, MD, Interim Chief of NORA, our team of board certified anesthesiologists and 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.
