Nonoperating Room Anesthesia and Procedural Sedation in Interventional Radiology: A Collaborative Framework for Safe Growth.

Interventional radiology (IR) has become one of the fastest expanding areas of procedural care, with increasing demand for image-guided diagnostic, vascular, oncologic, and emergency interventions. This growth has created parallel demands for both procedural sedation (PS) and anesthesiology services, the so-called nonoperating room anesthesia (NORA) within the IR suite. These services should not be viewed as competing models, but as different points on a continuum in which the level of sedation or anesthesia is matched to the patient, procedure, location, level of care, clinicians' qualifications and rescue resources. The 2023 American Society of Anesthesiologists (ASA) Statement on Nonoperating Room Anesthesia Services emphasizes that NORA locations require operating room-level leadership, equipment, staffing, scheduling, quality oversight, emergency preparedness, and information-system support. In parallel, implementation of anesthesiology oversight for PS can standardize education, credentialing, monitoring, recovery criteria, reporting, regulatory survey readiness, and quality improvement across procedural areas. This article proposes a triage framework to distinguish PS from NORA in IR and an operational model for safely expanding both services. A brief PS vignette and 2 detailed NORA examples, pulmonary artery mechanical thrombectomy and transthoracic lung cancer cryoablation, demonstrate how physiology, procedural complexity, airway access, positioning, and rescue planning determine the safest model of care. When IR and anesthesiology operate as a coordinated system, patients receive the proper and safest level of care, procedural services expand safely, and health systems are better positioned for rising demand.