Non Operating Room Anaesthesia

Learn about Non Operating Room Anaesthesia with simple exam tips, safety guidelines, and easy-to-follow anesthesia practices.

NORA Protocols and Monitoring

The NORA Study Guide is designed for anesthesiology residents and professionals preparing for exams or enhancing their skills in out-of-OR environments. It offers well-organized content, updated MCQs, and key principles for safe anesthesia delivery in locations like imaging suites, endoscopy rooms, and interventional radiology.

Whether you’re reviewing basic principles or diving into advanced topics like sedation, remote monitoring, and patient safety, this resource helps you learn with clarity and confidence. It features downloadable summaries, flashcards, and practice tests that simulate real exam formats.

Beyond the basics, you’ll find expert advice, simplified explanations, and focused strategies to reinforce key concepts and ensure exam readiness.

Topics include airway management, sedation techniques, equipment safety, patient evaluation, and risk minimization. Diagrams and quick-reference tools make complex ideas easier to understand. Whether you’re studying for certification or refining your daily clinical approach, this guide is a reliable learning partner for every anesthesia provider working beyond the operating room

Training Resources for NORA Anesthesiologists

MCQ Practice: Assess your understanding with a curated set of multiple-choice questions specific to NORA. These are regularly refreshed to reflect current standards and are ideal for trainees, residents, and clinical practitioners.

Structured Content: Access a collection of clear, concise notes focused on Non Operating Room Anaesthesia. Each subject is broken down into manageable sections to improve comprehension and long-term recall. These resources support both practical learning and exam preparation.

Welcome to your NORA (Non Operating Room Anaesthesia

Which of the following is a primary consideration when providing anesthesia for NORA (Non-Operating Room Anesthesia) procedures?

Cardiovascular status of the patient

Operating room sterility protocols

Knowledge of the surgical procedure

Airway management with advanced airway tools

Which of the following types of procedures would most likely require anesthesia in a radiology suite for NORA?

MRI

CT scan

PET scan

Ultrasound

In which of the following situations would a general anesthetic be most appropriate for a NORA procedure?

Colonoscopy

Bone marrow biopsy

Bronchoscopy

Aortic stent placement

Which of the following medications is most commonly used for sedation during NORA procedures?

Midazolam

Propofol

Etomidate

Ketamine

What is the most critical equipment to have available during a NORA procedure performed under sedation?

Defibrillator

Endotracheal tube

Laryngoscope

Oxygenation equipment

In a pediatric NORA procedure, the anesthesiologist should be especially cautious about:

Maintaining an adequate airway

The duration of the procedure

Monitoring for hypothermia

The use of reversal agents

Which of the following is a common complication during NORA procedures involving sedation?

Hyperglycemia

Hypoventilation

Hypertension

Postoperative nausea and vomiting (PONV)

When considering anesthesia for a patient undergoing a NORA procedure in the MRI suite, which of the following is most crucial?

The patient's age

The patient's mobility

MRI-compatible monitoring equipment

The patient's surgical history

Which of the following is a key challenge specific to NORA procedures in the catheterization lab (cardiac cath lab)?

Maintaining aseptic technique

Ensuring proper ventilation in a small space

Managing contrast media side effects

Maintaining constant body temperature

10.

Which of the following is a typical complication associated with regional anesthesia during NORA procedures?

Seizures

Hematoma at the injection site

Anaphylaxis

Hypotension

11.

In NORA, what is the role of the anesthesia provider during a diagnostic endoscopy procedure (e.g., bronchoscopy)?

To administer the local anesthetic and perform the procedure

To monitor and ensure the patient’s comfort and safety during sedation

To perform the endoscopy while ensuring that the patient remains conscious

To provide post-procedure analgesia

12.

Which of the following is a significant risk associated with sedation during NORA procedures in non-OR environments?

Aspiration pneumonia

Cerebral edema

Malignant hyperthermia

Increased intraocular pressure

13.

For a patient undergoing an interventional radiology procedure requiring NORA, what is the most important monitoring parameter?

Blood pressure

Oxygen saturation

Electrocardiogram (ECG)

Temperature

14.

In a NORA setting, which of the following factors is most likely to impact drug choice for anesthesia?

The patient’s body weight

The duration of the procedure

The facility's location

The patient's previous surgical history

15.

Which of the following NORA settings is most likely to require a comprehensive airway management plan?

MRI scan

Gastrointestinal endoscopy

Cardioversion

Percutaneous nephrostomy

16.

What is the most common site for regional anesthesia (nerve block) in NORA procedures?

Femoral nerve

Brachial plexus

Sciatic nerve

Intercostal nerve

17.

Which of the following statements is true about the use of sedation in NORA procedures for elderly patients?

Older adults require higher doses of sedatives

Sedation should be avoided in elderly patients due to the risk of delirium

Elderly patients have an increased sensitivity to sedatives

Sedation in elderly patients should always involve the use of opioids

18.

Which of the following procedures is least likely to require the involvement of an anesthesiologist in a NORA setting?

Endoscopic retrograde cholangiopancreatography (ERCP)

Electrophysiological studies

Bronchoscopy

Endoscopic sinus surgery

19.

For a NORA procedure involving sedation, the most likely cause of hypoxia is:

) Poor patient positioning

Use of opioids

nadequate monitoring

Inadequate analgesia

20.

In the context of NORA, which of the following is a major benefit of using monitored anesthesia care (MAC) over general anesthesia?

Increased patient comfort

Lower cost and shorter recovery time

Better control over the airway

Fewer drug interactions

21.

Which of the following is a specific challenge when performing NORA in a non-sterile environment?

Difficulty maintaining patient monitoring

Limited ability to use sedatives

Inability to administer intravenous fluids

22.

What is the primary concern when administering regional anesthesia (e.g., lumbar plexus block) in a NORA setting?

Risk of local anesthetic toxicity

Risk of nerve injury

Difficulty achieving a dense block

Inadequate analgesia during the procedure

23.

Which of the following is the most appropriate choice of anesthetic agent for sedation during a NORA procedure in a pediatric patient?

Etomidate

Ketamine

Fentanyl

Propofol

24.

In a NORA setting, the anesthesiologist must monitor the patient for:

Respiratory depression and oxygen desaturation

Sudden increases in blood pressure

Allergic reactions to contrast agents

Surgical complications

25.

Which of the following NORA procedures may require an advanced airway management technique due to patient positioning?

CT scan

Endoscopy

Cardiac catheterization

Lumbar puncture

26.

For patients undergoing a NORA procedure under sedation, which of the following should be done to prevent aspiration?

Ensure the patient is fasted for at least 8 hours

Place the patient in the Trendelenburg position

Use a cuffed endotracheal tube

Apply an oropharyngeal airway

27.

What is the most appropriate response if a patient experiences airway obstruction during a NORA procedure under sedation?

Administer naloxone to reverse sedation

Increase the oxygen flow rate

Attempt non-invasive positive pressure ventilation

Immediately administer general anesthesia

28.

In NORA, what is the most common complication associated with deep sedation in an MRI suite?

Anaphylaxis to contrast media

Patient movement during the procedure

Seizure due to the magnetic field

Airway compromise and hypoxia

29.

Which of the following is a specific challenge when performing NORA in a dental procedure?

Access to the patient's airway is often difficult

The procedure may be too short to require anesthesia

The patient is typically not fasting prior to the procedure

Patients are typically in the seated position, making airway management more challenging

30.

Which of the following monitoring tools is most appropriate during a NORA procedure requiring deep sedation or general anesthesia?

Pulse oximetry and capnography

Blood glucose monitoring

Electroencephalography (EEG)

Invasive blood pressure monitoring

31.

What should be the first step in managing a patient who becomes hypotensive during a NORA procedure?

Administer a vasopressor immediately

Check the patient’s fluid status and give intravenous fluids

Increase the sedation dose

Perform an urgent ECG

32.

Which of the following factors is most likely to alter the pharmacokinetics of anesthetic drugs during NORA procedures?

The patient’s weight

The patient’s age and comorbidities

The type of procedure

The use of regional anesthesia

33.

During a NORA procedure involving sedation in a radiology suite, which of the following is a critical safety feature that should always be available?

An anesthesia machine with gas delivery

A crash cart with resuscitation drugs

A post-procedure recovery area

A ventilator

34.

For a patient undergoing a NORA procedure under sedation, which of the following is the most important aspect of patient monitoring?

Level of consciousness

Temperature

Oxygen saturation and ventilation

Blood pressure

35.

Oxygen saturation and ventilation are critical during sedation, as sedative drugs can depress respiratory drive. Monitoring these parameters ensures that the patient maintains adequate oxygenation and ventilation throughout the procedure.

Immediately administer a paralytic and secure the airway

Attempt bag-valve-mask ventilation and consider intubation

Increase the sedative dosage

Monitor and wait for the sedation to wear off

36.

Which of the following patient characteristics is most likely to increase the risk of complications during NORA procedures?

A healthy, young adult with no medical comorbidities

A morbidly obese patient with obstructive sleep apnea

A patient who has fasted for more than 12 hours

A patient with a normal ECG and no history of heart disease

37.

Which of the following NORA procedures most often requires the use of a deep level of sedation or general anesthesia?

Colonoscopy

Bronchoscopy with biopsy

Transesophageal echocardiography (TEE)

Mammography

38.

Which of the following is the best approach for managing a patient with an allergy to contrast agents undergoing a NORA procedure in a radiology suite?

Pre-medicate with a sedative to minimize allergic reaction

Administer antihistamines and corticosteroids prior to the procedure

Avoid any pre-procedural medication

Proceed without concern as contrast allergies are very rare

39.

When performing NORA in a patient with known difficult airways, which of the following is the most important consideration?

Using a higher dose of sedative medications

Having advanced airway management equipment readily available

Using a non-invasive ventilation device

Performing the procedure with minimal sedation

40.

Which of the following is a common complication of deep sedation during a NORA procedure?

Hypertension and tachycardia

Hypoxia and respiratory depression

Hyperthermia

Hyponatremia

41.

What is the primary goal of sedation for NORA procedures?

To provide full general anesthesia and complete muscle relaxation

To provide an adequate level of sedation for patient comfort while allowing the procedure to proceed smoothly

To prevent all forms of pain sensation during the procedure

To ensure the patient is completely unconscious and unaware of the procedure

42.

Which of the following medications is commonly used for procedural sedation in NORA settings due to its rapid onset and short duration of action?

Midazolam

Propofol

Ketamine

Fentanyl

43.

What is the most common complication when performing regional anesthesia in a NORA setting?

Post-dural puncture headache

Nerve injury

Hypotension

Hematoma

44.

Which of the following is the most appropriate intervention for managing a patient with hypotension and bradycardia during a NORA procedure?

Administer atropine and ephedrine

Increase the sedative dosage

Discontinue the procedure immediately

Initiate immediate endotracheal intubation

45.

In the context of NORA, which of the following is the most significant concern when performing a procedure in a patient with a history of malignant hyperthermia (MH)?

Inadequate sedation

Risk of severe hyperkalemia and muscle rigidity

Inability to manage airway effectively

Increased sensitivity to sedative agents

46.

Which of the following patient populations is most likely to benefit from the use of nitrous oxide during a NORA procedure?

Pediatric patients

Elderly patients with comorbidities

Patients undergoing bronchoscopy

Patients undergoing minor dental procedures

47.

In the NORA setting, what is the preferred method for monitoring the patient’s depth of sedation?

Bispectral Index (BIS)

Pulse oximetry

Electrocardiogram (ECG)

Non-invasive blood pressure monitoring

48.

In a NORA procedure, which of the following is the most appropriate sedation technique for a patient with a history of anxiety and claustrophobia undergoing MRI?

General anesthesia

Oral benzodiazepines and nitrous oxide

Spinal anesthesia

Local anesthesia and moderate sedation

49.

During a NORA procedure, which of the following monitoring parameters is essential for detecting and preventing the most common complications of deep sedation?

ECG for arrhythmias

End-tidal CO2 and pulse oximetry

Temperature monitoring

Intracranial pressure monitoring

50.

What is the recommended action when a patient develops severe hypoxia during a NORA procedure in the radiology suite?

Administer additional sedative agents

Attempt to reposition the patient and provide supplemental oxygen

Immediately discontinue the procedure and awaken the patient

Continue the procedure with minimal intervention

Name

Radiation Safety for Anesthesiologists

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