This second edition reflects the rapid expansion of anesthesia practice beyond the operating room and provides a focused, practical guide for clinicians working in these increasingly complex environments. It emphasizes the physiologic and logistical challenges unique to non‑OR settings and offers clear, procedure‑specific strategies for managing sedation and anesthesia across gastroenterology, pulmonology, cardiology, radiology, and other high‑growth specialties. The text highlights current best practices for maintaining safety in locations where resources, space, and staffing differ significantly from the traditional operating room.

Out of Operating Room Anesthesia: A Comprehensive Review, 2^nd Edition presents an up‑to‑date overview of the modern procedures and technologies that now define non‑OR anesthesia. Robot‑assisted and electromagnetic bronchoscopy, endobariatric interventions, endoscopic submucosal dissection, irrigated needle ablation for refractory arrhythmias, and endobronchial valve placement are covered with detailed anesthesia implications and workflow guidance. The book also examines advances in monitoring and airway management, including the oxygen reserve index (ORi), specialized endoscopy masks, and nasal CPAP systems that support oxygenation during deep sedation. Pharmacologic updates address the evolving role of remimazolam, the impact of sugammadex on neuromuscular blockade strategies, and the use of newer sedatives and opioids tailored for short, minimally invasive procedures.

Basavana G. Goudra, MD, FRCA, FCARCSI, FASA, is Professor of Anesthesiology and Critical Care Medicine at Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA, and Medical Director of Jefferson Surgical Center Endoscopy. He received his medical degree from Bangalore Medical College, India, and completed his residency at the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry. Following specialist training in Ireland, he pursued a fellowship in pediatric anesthesia at Cincinnati Children's Hospital Medical Center before serving as Consultant Anesthetist at Russells Hall Hospital, NHS, England. He was a faculty member at the Hospital of the University of Pennsylvania and Perelman School of Medicine for more than 15 years before joining Jefferson Health in 2024. Dr. Goudra is internationally recognized for his work in non-operating room anesthesia (NORA), total intravenous anesthesia, gastrointestinal endoscopy anesthesia, airway management, and procedural sedation. He has authored more than 120 peer-reviewed publications, book chapters, and textbooks, and his research has significantly influenced contemporary practice in NORA. He has also served as a member and a consultant to the U.S. Food and Drug Administration (FDA) Anesthetic and Analgesic Drug Products/Drug Safety and Risk Management Advisory Committee.

Michael S. Green, DO, MBA, FASA is Professor and Chair, Department of Anesthesiology and Perioperative Medicine at the Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA and the Clinical Leader of Enterprise Perioperative Services for the Jefferson Health System. Michael earned his medical degree from the University of Medicine and Dentistry of New Jersey, Master’s in Business Administration from Washington State University, and completed Leadership Training at the Harvard School of Public Health.  He completed residency in Anesthesiology at Drexel College of Medicine and spent 15 years on faculty at Hahnemann University Hospital prior to moving to Thomas Jefferson University Hospital in 2019. His experience includes being a member of the Committee on Practice Management for the American Society of Anesthesiologists, a board member for the Pennsylvania Society of Anesthesiologists, an alternate member of the house of delegates representing Pennsylvania, member ACGME Group on Residency Affairs, and the Resident and Medical Student Committee for the state of Pennsylvania.