Out-of-the-operating room (NORA, non-operating room anesthesia) anesthesia care is certainly one of the growth areas of many anesthesiology practices. And despite this being an area of increasing case numbers, there is sometimes trepidation on the part of physician anesthesiologists about providing care in these locations. When administering anesthetics for patients outside of the O.R., more often than not we are well out of our usual comfort zone. For instance, in my practice, one group of patients we care for are the left ventricular assist device (LVAD) patients who need to undergo gastrointestinal endoscopy procedures. You see, we provide anesthesia care for a heart failure service. We are there for every LVAD placement and all extra-corporeal membrane oxygenator decannulations. Of course, we do anesthesia for heart and lung transplants. Thus, we are there when the LVAD patients need to have...

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