Incidence and risk factors of complications after non-operating room anesthesia in children: a prospective observational study

Incidence and risk factors of complications after non-operating room anesthesia in children: a prospective observational study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Incidence and risk factors of complications after non-operating room anesthesia in children: a prospective observational study Hamza Kassimi, Khalil Abouelalaa, Abderrahmane ELwali, Ennouali Hassan, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7923178/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Non-operating room anesthesia (NORA) is increasingly utilized in pediatric practice, but complications remain a concern, particularly in resource-limited settings. Objective To determine the incidence of complications during pediatric NORA and identify associated risk factors. Methods This prospective observational study included 300 children undergoing sedation or anesthesia for diagnostic and therapeutic procedures in radiology and endoscopy departments of a university hospital. Demographics, medical history, procedural details, and complications were recorded. Univariable and multivariable logistic regression analyses were performed to identify independent risk factors. Results The overall complication rate was 8.7% (26/300). Respiratory complications were most frequent (57.7%), followed by emergence agitation (30.8%). Independent risk factors included respiratory distress (adjusted OR = 6.845; 95% CI: 1.986–23.583; p = 0.002), altered consciousness (aOR = 9.127; 95% CI: 1.124–74.123; p = 0.038), and recent upper respiratory infection (aOR = 4.921; 95% CI: 1.042–23.230; p = 0.044). Preanesthetic consultation was protective (aOR = 0.389; 95% CI: 0.154–0.982; p = 0.046). No mortality occurred. Conclusions Complications during pediatric NORA remain significant. Careful patient selection, thorough preanesthetic evaluation, and awareness of risk factors can improve safety. Systematic preanesthetic consultation should be implemented for all pediatric NORA procedures. Non-operating room anesthesia pediatric anesthesia complications risk factors sedation patient safety INTRODUCTION Non-operating room anesthesia (NORA) has become an integral component of pediatric medical care, with an increasing number of diagnostic and therapeutic procedures requiring sedation or anesthesia outside the traditional operating room environment [ 1 ]. These procedures include magnetic resonance imaging (MRI), computed tomography (CT), endoscopy, bone marrow biopsies, and various interventional radiology procedures. The unique challenges of NORA include unfamiliar environments, equipment limitations, inadequate monitoring facilities, and often limited access to the patient during procedures [ 2 ]. Pediatric patients present particular challenges for NORA due to their inability to cooperate, anatomical and physiological differences, and the need for immobility during diagnostic imaging [ 3 , 4 ]. While NORA facilitates essential medical procedures in children, it carries inherent risks that may differ from those encountered in conventional operating room settings. Studies report that in pediatric non-operating room anesthesia (NORA), the incidence of complications can be as low as 2–3% in well-resourced settings, but can rise to 8.6% or more in low- and middle-income countries. [ 5 , 6 ]. Despite the growing body of literature on pediatric NORA, there remains a paucity of data from LMICs, where healthcare systems face unique constraints. Furthermore, few studies have comprehensively examined the protective role of preanesthetic evaluation in reducing complications during pediatric NORA procedures. The primary aim of this study was to determine how often complications occur in children undergoing anaesthesia outside the operating room for diagnostic and therapeutic procedures in our institution. Secondary aims were to describe the types and severity of those complications; identify risk factors; evaluate whether pre-anaesthetic consultation offers protection; assess how patients’ health status and comorbidities influence complication rates; and make recommendations to improve safety in pediatric NORA. METHODS Study Design and Setting This prospective observational study was conducted over 12 months in the radiology and endoscopy departments of a university hospital. Ethical approval was obtained from the institutional review board, and informed consent was secured from parents or legal guardians. Study Population Children aged 0–12 years scheduled for elective or urgent diagnostic or therapeutic procedures under anesthesia or sedation outside the operating room (radiology or endoscopy units) were eligible. Only ASA physical status I–II patients were included. Exclusion criteria were emergency procedures, ASA ≥ III, known anesthetic allergy, refusal of consent, or incomplete data. Anesthetic Management All patients were evaluated preoperatively by an anesthesiologist. When performed, preanesthetic consultations occurred within 7 days of the procedure and included clinical assessment and airway evaluation. Fasting adhered to standard guidelines (6 h for solids, 4 h for breast milk, 2 h for clear fluids). Anesthesia techniques included sevoflurane inhalation, intravenous propofol, or ketamine–midazolam combinations. Airway management used nasal cannula, face mask, or high-flow oxygen with spontaneous ventilation. Standard monitoring comprised continuous pulse oximetry, ECG, and non-invasive blood pressure every 5 minutes; capnography was added when available. Procedures were performed by specialty teams with an anesthesiologist present throughout. Data Collection A standardized form recorded demographics, medical history, ASA status, procedure characteristics (type, duration, operator experience), anesthetic technique, airway management, and preanesthetic consultation. Outcomes included intra- and post-procedural complications, their severity, interventions, and need for ICU admission. Definitions Complications were defined as any intra- or post-anesthetic adverse event requiring intervention. Respiratory: desaturation (SpO₂ < 90%), laryngospasm, bronchospasm, apnea, airway obstruction. Cardiovascular: bradycardia, hypotension, arrhythmia. Others: vomiting, emergence agitation, seizures, prolonged unconsciousness. Severity was classified as minor (simple management, no sequelae) or major (requiring intensive intervention or ICU transfer). Critically ill children were those with respiratory distress, altered consciousness, or acute decompensation. Statistical Analysis Data were analyzed using SPSS v26 (IBM, Armonk, NY). Continuous variables were summarized as mean ± SD and compared using t- or Mann–Whitney U-tests; categorical variables as frequencies (%) and compared with chi-square or Fisher’s exact tests. Variables with p < 0.20 in univariable analysis entered a multivariable logistic regression model with backward elimination. Results were expressed as odds ratios (OR) with 95% confidence intervals (CI). Model discrimination and calibration were assessed using the C-statistic and Hosmer-Lemeshow test. A p < 0.05 was considered statistically significant. RESULTS Study population and incidence of complications During the study period, a total of 300 children who underwent sedation or anesthesia in the radiology and endoscopy departments were included in this prospective observational study. Among these patients, 26 (8.7%) experienced at least one complication during or immediately after the procedure, constituting our complications group. The remaining 274 (91.3%) patients had uneventful procedures and formed the no-complications group. The overall incidence of complications was 8.7% (95% CI: 5.8-12.4%). The mean age of the study population was 3.5 ± 2.4 years, with a mean weight of 13.8 ± 6.1 kg. Male patients represented 57.7% (n = 173) of the cohort. Patient demographics and clinical characteristics Table 1 presents the demographic and clinical characteristics of patients in both groups. Patients who experienced complications were significantly younger (mean age: 2.8 ± 2.1 years vs. 3.6 ± 2.4 years, p = 0.042) and had lower mean weight (11.9 ± 5.3 kg vs. 14.0 ± 6.2 kg, p = 0.048). There was no significant difference in gender distribution between groups (male: 61.5% vs. 57.3%, p = 0.663). Table 1. Demographic and Clinical Characteristics of Study Population Variable Complications Group (n = 26) No Complications Group (n = 274) p-value Age (years), mean ± SD 2.8 ± 2.1 3.6 ± 2.4 0.042* Weight (kg), mean ± SD 11.9 ± 5.3 14.0 ± 6.2 0.048* Male gender, n (%) 16 (61.5%) 157 (57.3%) 0.663 ASA Classification ASA I, n (%) 14 (53.8%) 177 (64.6%) 0.256 ASA II, n (%) 12 (46.2%) 97 (35.4%) Medical History Neurological disease, n (%) 8 (30.8%) 62 (22.6%) 0.344 Respiratory disease, n (%) 11 (42.3%) 85 (31.0%) 0.223 Cardiac disease, n (%) 2 (7.7%) 8 (2.9%) 0.177 Recent URI (<15 days), n (%) 3 (11.5%) 6 (2.2%) 0.012* Type of Procedure CT scan, n (%) 12 (46.2%) 135 (49.3%) 0.752 MRI, n (%) 9 (34.6%) 95 (34.7%) 0.992 Bone marrow biopsy, n (%) 2 (7.7%) 24 (8.8%) 0.853 Endoscopy, n (%) 3 (11.5%) 20 (7.3%) 0.439 Duration of procedure (min), mean ± SD 15.8 ± 10.9 17.2 ± 11.3 0.522 SD: standard deviation; URI: upper respiratory infection; ASA: American Society of Anesthesiologists * p < 0.05 statistically significant Patients with ASA II classification represented 46.2% of the complications group compared to 35.4% in the no-complications group, though this difference did not reach statistical significance (p = 0.256). A history of recent upper respiratory infection within 15 days was significantly more common in the complications group (11.5% vs. 2.2%, p = 0.012). Anesthetic management Table 2 summarizes the anesthetic techniques and agents used during the procedures. Sevoflurane was the most commonly used anesthetic agent (87.3%, n = 262), followed by propofol (8.3%, n = 25), and ketamine with midazolam combination (4.3%, n = 13). Table 2. Anesthetic Management Characteristics Variable Complications Group (n = 26) No Complications Group (n = 274) p-value Anesthetic Agent Sevoflurane, n (%) 21 (80.8%) 241 (88.0%) 0.287 Propofol, n (%) 3 (11.5%) 22 (8.0%) 0.532 Ketamine + Midazolam, n (%) 2 (7.7%) 11 (4.0%) 0.347 Airway Management High-flow face mask, n (%) 19 (73.1%) 211 (77.0%) 0.644 Nasal cannula, n (%) 5 (19.2%) 50 (18.2%) 0.905 Facial mask, n (%) 2 (7.7%) 13 (4.7%) 0.481 IV Access IV line established, n (%) 7 (26.9%) 81 (29.6%) 0.770 Preanesthetic Consultation Consultation performed, n (%) 8 (30.8%) 152 (55.5%) 0.013* Operator Experience Specialist, n (%) 21 (80.8%) 228 (83.2%) 0.747 Resident, n (%) 4 (15.4%) 38 (13.9%) 0.831 Professor, n (%) 1 (3.8%) 8 (2.9%) 0.789 Recovery Location On table, n (%) 19 (73.1%) 239 (87.2%) 0.040* Recovery room, n (%) 6 (23.1%) 35 (12.8%) ICU, n (%) 1 (3.8%) 0 (0%) IV: intravenous; ICU: intensive care unit * p < 0.05 statistically significant Preanesthetic consultation within a few days before the NORA procedure was performed in only 30.8% of patients in the complications group compared to 55.5% in the no-complications group (p = 0.013), suggesting a protective effect. Recovery location differed significantly between groups, with more patients in the complications group requiring recovery room or ICU admission (26.9% vs. 12.8%, p = 0.040). Types and severity of complications Table 3 describes the types and frequencies of complications observed during NORA procedures. Respiratory complications were the most frequent (57.7%, n = 15), followed by emergence agitation (30.8%, n = 8), cardiovascular complications (11.5%, n = 3), and gastrointestinal complications (11.5%, n = 3). Table 3. Types and Distribution of Complications Type of Complication n Percentage of Complications (%) Incidence in Total Cohort (%) Respiratory complications 15 57.7 5.0 - Desaturation (SpO₂ < 90%) 11 42.3 3.7 - Cough 1 3.8 0.3 - Bronchospasm 3 11.5 1.0 Emergence agitation 8 30.8 2.7 Cardiovascular complications 3 11.5 1.0 - Bradycardia 3 11.5 1.0 Gastrointestinal complications 3 11.5 1.0 - Vomiting 3 11.5 1.0 Neurological complications 1 3.8 0.3 - Convulsive emergence delirium 1 3.8 0.3 Total patients with complications 26 100 8.7 Some patients experienced more than one complication Desaturation (oxygen saturation below 90%) was the single most common complication, occurring in 11 patients (3.7% of total cohort, 42.3% of complications). All desaturation episodes were managed successfully with airway maneuvers, increased oxygen supplementation, and in some cases, temporary cessation of the procedure. No patient required endotracheal intubation for complication management. Among the 26 complications, 20 (76.9%) were classified as minor, requiring minimal intervention, while 6 (23.1%) were major complications necessitating significant therapeutic interventions or unplanned transfer. One patient with convulsive emergence delirium required transfer to the intensive care unit for observation and eventually recovered without sequelae. No mortality was observed in this cohort. Risk factors for complications Univariable analysis Table 4 presents the results of univariable logistic regression analysis identifying potential risk factors for complications during NORA. Several variables showed significant associations with increased risk of complications in the univariable analysis. Table 4. Univariable Analysis of Risk Factors for Complications Variable Complications n/N (%) No Complications n/N (%) OR 95% CI p-value Age < 2 years 12/26 (46.2%) 78/274 (28.5%) 2.159 0.975-4.783 0.057 Weight < 10 kg 10/26 (38.5%) 64/274 (23.4%) 2.046 0.903-4.637 0.085 Male gender 16/26 (61.5%) 157/274 (57.3%) 1.194 0.529-2.696 0.663 ASA II vs ASA I 12/26 (46.2%) 97/274 (35.4%) 1.564 0.711-3.442 0.265 Neurological disease 8/26 (30.8%) 62/274 (22.6%) 1.514 0.633-3.619 0.350 Respiratory disease 11/26 (42.3%) 85/274 (31.0%) 1.634 0.736-3.628 0.227 Cardiac disease 2/26 (7.7%) 8/274 (2.9%) 2.784 0.570-13.593 0.203 Recent URI (<15 days) 3/26 (11.5%) 6/274 (2.2%) 5.821 1.377-24.600 0.017* Difficult intubation predicted 2/26 (7.7%) 5/274 (1.8%) 4.481 0.830-24.202 0.081 Current URI 2/26 (7.7%) 4/274 (1.5%) 5.563 0.986-31.396 0.052 Altered consciousness 2/26 (7.7%) 2/274 (0.7%) 11.333 1.531-83.948 0.017* Respiratory distress 5/26 (19.2%) 8/274 (2.9%) 7.889 2.413-25.801 20 min 9/26 (34.6%) 89/274 (32.5%) 1.099 0.478-2.524 0.824 OR: odds ratio; CI: confidence interval; URI: upper respiratory infection; ASA: American Society of Anesthesiologists; IV: intravenous * p < 0.05 statistically significant The strongest predictors in univariable analysis were: altered consciousness at presentation (OR = 11.333; 95% CI: 1.531-83.948; p = 0.017), respiratory distress (OR = 7.889; 95% CI: 2.413-25.801; p < 0.001), and recent upper respiratory infection within 15 days (OR = 5.821; 95% CI: 1.377-24.600; p = 0.017). Preanesthetic consultation performed a few days before the procedure was associated with a significantly reduced risk of complications (OR = 0.358; 95% CI: 0.153-0.836; p = 0.018), suggesting a protective effect. Multivariable analysis Variables with p-values < 0.20 in the univariable analysis were entered into the multivariable logistic regression model. Table 5 shows the results of the multivariable analysis after adjusting for potential confounders. Table 5. Multivariable Logistic Regression Analysis for Predictors of Complications Variable Adjusted OR 95% CI p-value Respiratory distress 6.845 1.986-23.583 0.002* Recent URI (<15 days) 4.921 1.042-23.230 0.044* Altered consciousness 9.127 1.124-74.123 0.038* Predicted difficult intubation 3.842 0.632-23.357 0.145 Preanesthetic consultation (protective) 0.389 0.154-0.982 0.046* OR: odds ratio; CI: confidence interval; URI: upper respiratory infection * p < 0.05 statistically significant After adjusting for confounders, four variables remained independently associated with complications. The most significant predictor was respiratory distress at presentation (aOR = 6.845; 95% CI: 1.986-23.583; p = 0.002), followed by altered consciousness (aOR = 9.127; 95% CI: 1.124-74.123; p = 0.038), and recent upper respiratory infection (aOR = 4.921; 95% CI: 1.042-23.230; p = 0.044). Preanesthetic consultation remained a significant protective factor after adjustment (aOR = 0.389; 95% CI: 0.154-0.982; p = 0.046), indicating that proper preanesthetic evaluation reduced the risk of complications by approximately 61%. The multivariable model showed good discriminative ability (C-statistic = 0.782; 95% CI: 0.699-0.865) and adequate calibration (Hosmer-Lemeshow test: χ² = 6.824, p = 0.447). Clinical status and patient condition Analysis of patient clinical status revealed that critically ill children (defined as those with respiratory distress, altered consciousness, or ASA II classification with acute illness) had a significantly higher complication rate. Of the 26 patients with complications, 15 (57.7%) were classified as critically ill compared to 49 (17.9%) in the no-complications group (OR = 6.256; 95% CI: 2.723-14.372; p < 0.001). Outcomes and recovery All patients eventually recovered and were discharged in stable condition. The one patient requiring ICU admission had convulsive emergence delirium and was discharged from ICU after 24 hours of observation without sequelae. No mortality was observed in this cohort. DISCUSSION This prospective observational study evaluated the incidence, nature, and predictors of complications during pediatric non-operating room anesthesia (NORA) and sedation procedures. Among 300 children managed in radiology and endoscopy units, the overall complication rate was 8.7% (95% CI 5.8–12.4%). The majority of adverse events were respiratory in nature, followed by emergence agitation and cardiovascular instability. Several clinical predictors were identified, including respiratory distress, altered consciousness, and recent upper respiratory infection, while pre-anesthetic consultation emerged as a significant protective factor. Incidence and pattern of complications The observed 8.7% incidence aligns with recent data from low- and middle-income countries (LMICs). Jarraya et al. [ 6 ] reported an almost identical rate of 8.6% among 256 children under 5 years undergoing NORA in Tunisia, where respiratory compromise and inadequate pre-assessment were the main contributors. Similarly, Amin, N [ 5 ] found a 3.2% incidence in a larger multicentric Indian cohort of 3631 procedures. In contrast, studies from high-resource context, including large multicenter databases from the pediatric sedation research consoritium [ 7 , 8 , 9 , 10 ] have consstently demonstrated overall complication rates between 5 and 7%, with respiratory adverse events being the most frequent. These findings collectively confirm that pediatric NORA procedures particulary in radiology and endoscopic, carry a non negligible complication risks, mainly due to the challenge of airway management and environmental limitatios high-resource settings [ 4 , 5 ]. These data collectively confirm that pediatric NORA procedures, particularly in radiology and endoscopy,carry a non-negligible complication risk, mainly due to the challenges of airway management and environmental limitations [ 2 , 3 ]. In our study, respiratory events accounted for 57.7% of all complications (5% of cases), consistent with other reports emphasizing that hypoxia, airway obstruction, and laryngospasm dominate pediatric NORA morbidity [ 5 , 11 ]. studies, respiratory and airway issues comprise a large fraction of NORA complications. In Mongodi, S et al.’s MRI cohort, 50% of all adverse events were respiratory in nature (3.1% of cases), predominantly airway obstruction (53.5%) and laryngospasm (23.3%) [ 12 ]. Similarly, Sirimontakan et al. observed that 3.9% of pediatric procedural sedations were complicated by respiratory events such as desaturation, laryngospasm, or apnea [ 13 ]. Even in large multicenter sedation registries, hypoxemia and airway compromise remain the most frequent adverse events. Cravero et al. reported that transient oxygen desaturation (SpO₂ < 90%) occurred in approximately 1.6% of sedations, while laryngospasm occurred in 0.043% of cases [ 9 ] The predominance of airway complications is multifactorial, reflecting both the anatomical and physiological susceptibility of children and the technical constraints inherent to remote, non-operating room environments. Predictors of complications Younger age and lower body weight were found to be significantly correlated with adverse perioperative outcomes, a relationship consistent with the findings of Ferrazzano et al. [ 11 ], who observed that smaller and younger uncooperative children sedated with propofol for MRI exhibited a higher incidence of respiratory instability. Physiologically, immature respiratory control mechanisms, diminished functional residual capacity, and elevated oxygen consumption render infants particularly susceptible to hypoventilation and oxygen desaturation. In our study cohort, respiratory distress emerged as the most significant independent predictor of complications (aOR = 6.845, p = .002), followed by altered consciousness (aOR = 9.127, p = .038) and a recent upper respiratory infection (aOR = 4.921, p = .044). These findings align with those of Jarraya et al. [ 6 ], who identified pre-existing respiratory symptoms and neurological impairment as major determinants of adverse sedation events in pediatric non-operating room anesthesia (NORA). Similarly, Beach et al. [ 14 ] demonstrated in a multicenter study that children with upper respiratory tract infections or airway hyperreactivity had significantly elevated rates of hypoxemia and laryngospasm during procedural sedation. In light of the substantial respiratory vulnerability associated with URIs, numerous expert reviews and specialty guidelines recommend postponing elective pediatric procedures for approximately two weeks after symptom resolution in cases of uncomplicated URIs [ 15 ]. For complicated or severe infections, characterized by lower airway involvement, wheezing, respiratory distress, persistent cough or fever, or the presence of underlying pulmonary disease, several reviews advocate for a delay of at least four weeks, extending to four to six weeks in certain high-risk cases [ 16 , 17 ]. Furthermore, some investigations and scoring systems, such as the COLDS and COLDS-like risk assessment tools, suggest waiting at least 15 days (≈ 2 weeks) for severe symptoms to subside; however, these frameworks emphasize the absence of universal consensus and recommend that postponement decisions be individualized according to symptom severity, comorbidities, and the inherent risk associated with the planned procedure [ 18 ]. Protective role of pre-anesthetic consultation In our prospective study, the pre-anesthetic consultation demonstrated a significant protective effect, reducing the likelihood of complications by 61% (aOR = 0.389; p = 0.046). This finding underscores the crucial role of systematic pre-procedure assessment in identifying comorbidities, anticipating airway challenges, and tailoring anesthetic management to individual patient needs. These results are consistent with those of Jarraya et al.[ 6 ], who reported that the absence of a pre-anesthetic evaluation was independently associated with a higher incidence of peri-procedural complications in pediatric NORA cases. Likewise, Khan et al. [ 19 ] in their scoping review on NORA safety events highlighted that structured pre-anesthetic screening and protocol standardization represent key strategies for minimizing adverse outcomes across diverse NORA environments. Collectively, the alignment between our findings and previous research reinforces the evidence that pre-anesthetic consultation serves as a critical safety measure, particularly in the paediatric population undergoing procedures outside the traditional operating-room environment. Anesthetic agents and procedural considerations In our cohort, the inhalational agent sevoflurane was the most frequently used anesthetic—consistent with prior paediatric NORA practices such as the ten-year MRI experience reported by Mongodi et al. [ 12 ] and others. Importantly, no specific anesthetic agent in our study emerged as an independent predictor of complications, which suggests that patient physiology and procedural context may outweigh pharmacologic choice in determining outcomes. This aligns with the findings of Amin et al., who studied 917 children and 3,631 NORA procedures and found an adverse-event incidence of 3.22% while identifying emergency status, anatomical site (abdomen/head-neck) and location (MRI/radiology suite) as the key predictors of morbidity rather than the anesthetic agent used [ 5 ]. Moreover, it is supported by Ferrazzano et al., who in a study of 109 uncooperative children undergoing NORA for dental treatment with propofol found a high success rate and minimal serious adverse effects, but identified intra-operative side-effects more strongly linked to age, health status and weight than to the drug itself [ 11 ]. Together, our findings and these prior studies reinforce that in paediatric NORA settings, procedural and patient-related factors, rather than specific anesthetic pharmacology, may drive safety outcomes, thereby underscoring the importance of pre-procedure planning, airway readiness, comorbidity optimisation and environment/logistics preparation. Critically ill status and outcomes Children presenting with acute illness or critical physiologic instability (such as respiratory distress, altered consciousness, or an acute American Society of Anesthesiologists (ASA) II status) had a six-fold higher risk of complications in our prospective cohort (OR = 6.256; p < 0.001). This observation echoes the findings of Incidence of complications after non‑operating room anesthesia in children in a low‑ and middle‑income country: A prospective and observational study by Jarraya et al. who identified critically-ill children (aOR ≈ 2.49) and predicted difficult airway (aOR ≈ 5.70) as independent predictors of adverse events [ 6 ]. Although earlier study by Beach et al. did not show acute illness per se as a major independent predictor of major adverse events in a broader pediatric sedation data-set, their large sample emphasised that higher ASA status and urgency of procedure correlated with increased risk [ 14 ]. Despite the elevated risk in critically-ill children in our study, we observed no mortality, which likely reflects effective monitoring, prompt intervention and high-quality care by trained anaesthesia personnel, a reassuring indicator of institutional safety standards. Clinical implications These findings underscore the importance of pre-anesthetic evaluation, patient optimization, and vigilant monitoring in all paediatric NORA procedures. Children with recent respiratory infections or neurological compromise should be considered high-risk, and their procedures should only be undertaken in settings with immediate access to airway-rescue equipment and adequate recovery facilities. The literature supports this: in their scoping review of NORA safety events, A Scoping Review on the Incidence of Nonoperating Room Anesthesia Safety Events emphasised the need for standardised definitions, structured screening, and protocol standardisation to minimise adverse events [ 19 ]. Likewise, Anaesthetic practices in non‑operating room settings for paediatric patients: A prospective observational study identified emergency status, anatomical site and procedural location as key predictors of morbidity in paediatric NORA, and emphasised that targeted protocols and staffing are necessary [ 5 ]. In addition, narrative reviews discussing NORA safety highlight the remote-location risks and call for mandatory checklists, team training, and consistent monitoring equivalent to OR standards [ 2 , 20 ]. Collectively, these data suggest that standardisation of NORA protocols, including mandatory pre-assessment, procedure-specific checklists, and post-sedation observation, are essential to minimise variability and enhance safety in paediatric non-operating room anesthesia. Limitations This single-center study has inherent limitations regarding generalizability. The sample size, although adequate for statistical modeling, remains modest compared with multicentric registries. Moreover, long-term outcomes were not evaluated, and subtle complications such as delayed desaturation or neurobehavioral effects may have been underestimated. Nevertheless, the prospective design, standardized data collection, and use of objective complication criteria lend robustness to these findings. CONCLUSION This prospective analysis identified a complication rate of 8.7% in pediatric non-operating room anesthesia, predominantly respiratory in nature. The most powerful predictors of complications were respiratory distress, altered consciousness, and recent upper respiratory infection, whereas pre-anesthetic consultation significantly reduced risk. These results, in harmony with recent international evidence, highlight the critical value of systematic pre-anesthesia assessment for procedural preparedness and multidisciplinary coordination in improving safety for pediatric NORA patients. Declarations DISCLOSURE AND FUNDING STATEMENT Funding This research received no external funding. Clinical trial number Not applicable. Human Ethics and Consent to Participate declarations The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Mohammed V Military Teaching Hospital (protocol code HMV-2024-045, approval date 2024). Written informed consent was obtained from the parents or legal guardians of all participants. CONFLICTS OF INTEREST The authors declare no conflict of interest. Ethical use of AI tools: We declare that AI-assisted tools were used in the literature research and drafting phases of this manuscript. All content was fully reviewed, edited and verified by the authors, who take full responsibility for the integrity, originality, and accuracy of the data and conclusions. Ethical guidelines for AI use in academic writing were followed. DATA AVAILABILITY STATEMENT The data that support the findings of this study are available from the corresponding author upon reasonable request AUTHOR CONTRIBUTIONS Conceptualization, H.K. and M.B.; Methodology, H.K.; Validation, H.K., K.A. and M.B.; Formal Analysis, H.K.; Investigation, H.K., K.A., A.H., E.H., A.E., H.B.; Data Curation, H.K.; Writing – Original Draft Preparation, H.K.; Writing – Review & Editing, H.K., M.B.; Supervision, M.B. ACKNOWLEDGMENTS The authors thank the medical and nursing staff of the Radiology and Endoscopy Departments of Mohammed V Military Teaching Hospital for their valuable cooperation during data collection. References Bell, C., & Sequeira, P. M. (2005). Nonoperating room anesthesia for children. Current opinion in anaesthesiology, 18(3), 271–276. https://doi.org/10.1097/01.aco.0000169234.06433.48 Kaye, A. D., Rogers, B. N., Mashaw, S., Mosieri, C. N., Urman, R. D., & Shekoohi, S. (2025). Safety of nonoperating room anesthesia: a narrative review. Current opinion in anaesthesiology, 38(4), 425–434. https://doi.org/10.1097/ACO.0000000000001542 Youn, A. M., Ko, Y. K., & Kim, Y. H. (2015). Anesthesia and sedation outside of the operating room. Korean journal of anesthesiology, 68(4), 323–331. https://doi.org/10.4097/kjae.2015.68.4.323 Maddirala, S., & Theagrajan, A. (2019). Non-operating room anaesthesia in children. Indian journal of anaesthesia, 63(9), 754–762. https://doi.org/10.4103/ija.IJA_486_19 Amin, N., Patil, P., & Sanapala, V. (2025). Anaesthetic practices in non-operating room settings for paediatric patients: A prospective observational study. Indian journal of anaesthesia, 69(5), 502–508. https://doi.org/10.4103/ija.ija_1057_24 Jarraya, A., Kammoun, M., Khcharem, J., Chérif, O., Feki, W., & Mnif, Z. (2024). Incidence of complications after nonoperating room anesthesia in children in a low- and middle-income country: A prospective and observational study. Pediatric Anesthesia , 34(9), 856-863. https://doi.org/10.1111/pan.14955 Kamat, P. P., McCracken, C. E., Gillespie, S. E., Fortenberry, J. D., Stockwell, J. A., Cravero, J. P., & Hebbar, K. B. (2015). Pediatric critical care physician-administered procedural sedation using propofol: a report from the Pediatric Sedation Research Consortium Database. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 16(1), 11–20. https://doi.org/10.1097/PCC.0000000000000273 Cravero, J. P., Beach, M. L., Blike, G. T., Gallagher, S. M., Hertzog, J. H., & Pediatric Sedation Research Consortium (2009). The incidence and nature of adverse events during pediatric sedation/anesthesia with propofol for procedures outside the operating room: a report from the Pediatric Sedation Research Consortium. Anesthesia and analgesia, 108(3), 795–804. https://doi.org/10.1213/ane.0b013e31818fc334 Cravero, J. P., Blike, G. T., Beach, M., Gallagher, S. M., Hertzog, J. H., Havidich, J. E., Gelman, B., & Pediatric Sedation Research Consortium (2006). Incidence and nature of adverse events during pediatric sedation/anesthesia for procedures outside the operating room: report from the Pediatric Sedation Research Consortium. Pediatrics, 118(3), 1087–1096. https://doi.org/10.1542/peds.2006-0313 Havidich, J. E., & Cravero, J. P. (2012). The current status of procedural sedation for pediatric patients in out-of-operating room locations. Current opinion in anaesthesiology, 25(4), 453–460. https://doi.org/10.1097/ACO.0b013e32835562d8 Ferrazzano, G. F., Cantile, T., Quaraniello, M., Iannuzzi, M., Palumbo, D., Servillo, G., Caruso, S., Fiasca, F., & Ingenito, A. (2021). Effectiveness and Safety of Intravenous Sedation with Propofol in Non-Operating Room Anesthesia (NORA) for Dental Treatment in Uncooperative Paediatric Patients. Children (Basel, Switzerland), 8(8), 648. https://doi.org/10.3390/children8080648 Mongodi, S., Ottonello, G., Viggiano, R. et al. Ten-year experience with standardized non-operating room anesthesia with Sevoflurane for MRI in children affected by neuropsychiatric disorders. BMC Anesthesiol 19, 235 (2019). https://doi.org/10.1186/s12871-019-0897-1 Sirimontakan T, Artprom N, Anantasit N. Efficacy and Safety of Pediatric Procedural Sedation Outside the Operating Room.Anesth Pain Med.2020;10(4):e106493.https://doi.org/10.5812/aapm.106493. Beach, M. L., Cohen, D. M., Gallagher, S. M., & Cravero, J. P. (2016). Major Adverse Events and Relationship to Nil per Os Status in Pediatric Sedation/Anesthesia Outside the Operating Room: A Report of the Pediatric Sedation Research Consortium. Anesthesiology, 124(1), 80–88. https://doi.org/10.1097/ALN.0000000000000933 Stepanovic, B., Regli, A., Becke-Jakob, K., & von Ungern-Sternberg, B. S. (2024). Preoperative preparation of children with upper respiratory tract infection: a focussed narrative review. British journal of anaesthesia, 133(6), 1212–1221. https://doi.org/10.1016/j.bja.2024.07.035 Lee, H. J., Woo, J. H., Cho, S., Oh, H. W., Joo, H., & Baik, H. J. (2020). Risk Factors for Perioperative Respiratory Adverse Events in Children with Recent Upper Respiratory Tract Infection: A Single-Center-Based Retrospective Study. Therapeutics and clinical risk management, 16, 1227–1234. https://doi.org/10.2147/TCRM.S282494 Regli, A., Becke, K., & von Ungern-Sternberg, B. S. (2017). An update on the perioperative management of children with upper respiratory tract infections. Current opinion in anaesthesiology, 30(3), 362–367. https://doi.org/10.1097/ACO.0000000000000460 Yu, S., Xu, C., Yao, J., Cai, J., Wei, R., & Jiang, Y. (2025). Association of upper respiratory tract infection with perioperative respiratory adverse events in pediatric tonsillectomy patients : A propensity-matched cohort study. Italian journal of pediatrics, 51(1), 146. https://doi.org/10.1186/s13052-025-02013-8 Khan, R., Sun, K. J., O'Connor, M., & Leung, J. M. (2025). A Scoping Review on the Incidence of Nonoperating Room Anesthesia Safety Events. Journal of patient safety, 21(5), 356–363. https://doi.org/10.1097/PTS.0000000000001342 Beard, J., Methangkool, E., Angus, S., Urman, R. D., & Cole, D. J. (2023). Consensus Recommendations for the Safe Conduct of Nonoperating Room Anesthesia: A Meeting Report From the 2022 Stoelting Conference of the Anesthesia Patient Safety Foundation. Anesthesia and analgesia, 137(2), e8–e11. https://doi.org/10.1213/ANE.0000000000006539 Additional Declarations No competing interests reported. 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study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eNon-operating room anesthesia (NORA) has become an integral component of pediatric medical care, with an increasing number of diagnostic and therapeutic procedures requiring sedation or anesthesia outside the traditional operating room environment [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. These procedures include magnetic resonance imaging (MRI), computed tomography (CT), endoscopy, bone marrow biopsies, and various interventional radiology procedures. The unique challenges of NORA include unfamiliar environments, equipment limitations, inadequate monitoring facilities, and often limited access to the patient during procedures [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePediatric patients present particular challenges for NORA due to their inability to cooperate, anatomical and physiological differences, and the need for immobility during diagnostic imaging [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. While NORA facilitates essential medical procedures in children, it carries inherent risks that may differ from those encountered in conventional operating room settings. Studies report that in pediatric non-operating room anesthesia (NORA), the incidence of complications can be as low as 2\u0026ndash;3% in well-resourced settings, but can rise to 8.6% or more in low- and middle-income countries. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite the growing body of literature on pediatric NORA, there remains a paucity of data from LMICs, where healthcare systems face unique constraints. Furthermore, few studies have comprehensively examined the protective role of preanesthetic evaluation in reducing complications during pediatric NORA procedures.\u003c/p\u003e\u003cp\u003eThe primary aim of this study was to determine how often complications occur in children undergoing anaesthesia outside the operating room for diagnostic and therapeutic procedures in our institution. Secondary aims were to describe the types and severity of those complications; identify risk factors; evaluate whether pre-anaesthetic consultation offers protection; assess how patients\u0026rsquo; health status and comorbidities influence complication rates; and make recommendations to improve safety in pediatric NORA.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis prospective observational study was conducted over 12 months in the radiology and endoscopy departments of a university hospital. Ethical approval was obtained from the institutional review board, and informed consent was secured from parents or legal guardians.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChildren aged 0\u0026ndash;12 years scheduled for elective or urgent diagnostic or therapeutic procedures under anesthesia or sedation outside the operating room (radiology or endoscopy units) were eligible. Only ASA physical status I\u0026ndash;II patients were included. Exclusion criteria were emergency procedures, ASA \u0026ge; III, known anesthetic allergy, refusal of consent, or incomplete data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnesthetic Management\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients were evaluated preoperatively by an anesthesiologist. When performed, preanesthetic consultations occurred within 7 days of the procedure and included clinical assessment and airway evaluation. Fasting adhered to standard guidelines (6 h for solids, 4 h for breast milk, 2 h for clear fluids).\u003c/p\u003e\n\u003cp\u003eAnesthesia techniques included sevoflurane inhalation, intravenous propofol, or ketamine\u0026ndash;midazolam combinations. Airway management used nasal cannula, face mask, or high-flow oxygen with spontaneous ventilation. Standard monitoring comprised continuous pulse oximetry, ECG, and non-invasive blood pressure every 5 minutes; capnography was added when available. Procedures were performed by specialty teams with an anesthesiologist present throughout.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA standardized form recorded demographics, medical history, ASA status, procedure characteristics (type, duration, operator experience), anesthetic technique, airway management, and preanesthetic consultation. Outcomes included intra- and post-procedural complications, their severity, interventions, and need for ICU admission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDefinitions\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eComplications were defined as any intra- or post-anesthetic adverse event requiring intervention.\u003c/li\u003e\n \u003cli\u003eRespiratory: desaturation (SpO₂ \u0026lt; 90%), laryngospasm, bronchospasm, apnea, airway obstruction.\u003c/li\u003e\n \u003cli\u003eCardiovascular: bradycardia, hypotension, arrhythmia.\u003c/li\u003e\n \u003cli\u003eOthers: vomiting, emergence agitation, seizures, prolonged unconsciousness.\u003c/li\u003e\n \u003cli\u003eSeverity was classified as minor (simple management, no sequelae) or major (requiring intensive intervention or ICU transfer).\u003c/li\u003e\n \u003cli\u003eCritically ill children were those with respiratory distress, altered consciousness, or acute decompensation.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were analyzed using SPSS v26 (IBM, Armonk, NY). Continuous variables were summarized as mean \u0026plusmn; SD and compared using t- or Mann\u0026ndash;Whitney U-tests; categorical variables as frequencies (%) and compared with chi-square or Fisher\u0026rsquo;s exact tests. Variables with p \u0026lt; 0.20 in univariable analysis entered a multivariable logistic regression model with backward elimination. Results were expressed as odds ratios (OR) with 95% confidence intervals (CI). Model discrimination and calibration were assessed using the C-statistic and Hosmer-Lemeshow test. A p \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eStudy population and incidence of complications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the study period, a total of 300 children who underwent sedation or anesthesia in the radiology and endoscopy departments were included in this prospective observational study. Among these patients, 26 (8.7%) experienced at least one complication during or immediately after the procedure, constituting our complications group. The remaining 274 (91.3%) patients had uneventful procedures and formed the no-complications group.\u003c/p\u003e\n\u003cp\u003eThe overall incidence of complications was 8.7% (95% CI: 5.8-12.4%). The mean age of the study population was 3.5 \u0026plusmn; 2.4 years, with a mean weight of 13.8 \u0026plusmn; 6.1 kg. Male patients represented 57.7% (n = 173) of the cohort.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient demographics and clinical characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 1 presents the demographic and clinical characteristics of patients in both groups. Patients who experienced complications were significantly younger (mean age: 2.8 \u0026plusmn; 2.1 years vs. 3.6 \u0026plusmn; 2.4 years, p = 0.042) and had lower mean weight (11.9 \u0026plusmn; 5.3 kg vs. 14.0 \u0026plusmn; 6.2 kg, p = 0.048). There was no significant difference in gender distribution between groups (male: 61.5% vs. 57.3%, p = 0.663).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Demographic and Clinical Characteristics of Study Population\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"4\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplications Group (n = 26)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo Complications Group (n = 274)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge (years), mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.8 \u0026plusmn; 2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.6 \u0026plusmn; 2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.042*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWeight (kg), mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.9 \u0026plusmn; 5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.0 \u0026plusmn; 6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.048*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale gender, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16 (61.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e157 (57.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.663\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eASA Classification\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eASA I, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14 (53.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e177 (64.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.256\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eASA II, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12 (46.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e97 (35.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedical History\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNeurological disease, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8 (30.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e62 (22.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.344\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRespiratory disease, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11 (42.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e85 (31.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.223\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCardiac disease, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2 (7.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8 (2.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.177\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRecent URI (\u0026lt;15 days), n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3 (11.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.012*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of Procedure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCT scan, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12 (46.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e135 (49.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.752\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMRI, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9 (34.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e95 (34.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.992\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBone marrow biopsy, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2 (7.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24 (8.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.853\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEndoscopy, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3 (11.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20 (7.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.439\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDuration of procedure (min), mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15.8 \u0026plusmn; 10.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17.2 \u0026plusmn; 11.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.522\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eSD: standard deviation; URI: upper respiratory infection; ASA: American Society of Anesthesiologists\u003c/em\u003e\u003cbr\u003e\u003cem\u003e* p \u0026lt; 0.05 statistically significant\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePatients with ASA II classification represented 46.2% of the complications group compared to 35.4% in the no-complications group, though this difference did not reach statistical significance (p = 0.256). A history of recent upper respiratory infection within 15 days was significantly more common in the complications group (11.5% vs. 2.2%, p = 0.012).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnesthetic management\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 summarizes the anesthetic techniques and agents used during the procedures. Sevoflurane was the most commonly used anesthetic agent (87.3%, n = 262), followed by propofol (8.3%, n = 25), and ketamine with midazolam combination (4.3%, n = 13).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Anesthetic Management Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"4\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplications Group (n = 26)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo Complications Group (n = 274)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnesthetic Agent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSevoflurane, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21 (80.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e241 (88.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.287\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePropofol, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3 (11.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22 (8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.532\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eKetamine + Midazolam, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2 (7.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11 (4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.347\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAirway Management\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHigh-flow face mask, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19 (73.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e211 (77.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.644\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNasal cannula, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 (19.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50 (18.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.905\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFacial mask, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2 (7.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13 (4.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.481\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIV Access\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIV line established, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7 (26.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e81 (29.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.770\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreanesthetic Consultation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eConsultation performed, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8 (30.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e152 (55.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.013*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOperator Experience\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSpecialist, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21 (80.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e228 (83.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.747\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eResident, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4 (15.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38 (13.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.831\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eProfessor, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1 (3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8 (2.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.789\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRecovery Location\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOn table, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19 (73.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e239 (87.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.040*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRecovery room, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6 (23.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35 (12.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eICU, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1 (3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eIV: intravenous; ICU: intensive care unit\u003c/em\u003e\u003cbr\u003e\u003cem\u003e* p \u0026lt; 0.05 statistically significant\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePreanesthetic consultation within a few days before the NORA procedure was performed in only 30.8% of patients in the complications group compared to 55.5% in the no-complications group (p = 0.013), suggesting a protective effect. Recovery location differed significantly between groups, with more patients in the complications group requiring recovery room or ICU admission (26.9% vs. 12.8%, p = 0.040).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTypes and severity of complications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 describes the types and frequencies of complications observed during NORA procedures. Respiratory complications were the most frequent (57.7%, n = 15), followed by emergence agitation (30.8%, n = 8), cardiovascular complications (11.5%, n = 3), and gastrointestinal complications (11.5%, n = 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Types and Distribution of Complications\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"4\" cellpadding=\"0\" width=\"650\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of Complication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage of Complications (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncidence in Total Cohort (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRespiratory complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e57.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e- Desaturation (SpO₂ \u0026lt; 90%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e42.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e- Cough\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e- Bronchospasm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmergence agitation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e30.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCardiovascular complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e- Bradycardia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGastrointestinal complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e- Vomiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNeurological complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e- Convulsive emergence delirium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal patients with complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eSome patients experienced more than one complication\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eDesaturation (oxygen saturation below 90%) was the single most common complication, occurring in 11 patients (3.7% of total cohort, 42.3% of complications). All desaturation episodes were managed successfully with airway maneuvers, increased oxygen supplementation, and in some cases, temporary cessation of the procedure. No patient required endotracheal intubation for complication management.\u003c/p\u003e\n\u003cp\u003eAmong the 26 complications, 20 (76.9%) were classified as minor, requiring minimal intervention, while 6 (23.1%) were major complications necessitating significant therapeutic interventions or unplanned transfer. One patient with convulsive emergence delirium required transfer to the intensive care unit for observation and eventually recovered without sequelae. No mortality was observed in this cohort.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRisk factors for complications\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eUnivariable analysis\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eTable 4 presents the results of univariable logistic regression analysis identifying potential risk factors for complications during NORA. Several variables showed significant associations with increased risk of complications in the univariable analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Univariable Analysis of Risk Factors for Complications\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"4\" cellpadding=\"0\" width=\"672\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 177px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplications n/N (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo Complications n/N (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 177px;\"\u003e\n \u003cp\u003eAge \u0026lt; 2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e12/26 (46.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e78/274 (28.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e2.159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.975-4.783\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 177px;\"\u003e\n \u003cp\u003eWeight \u0026lt; 10 kg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e10/26 (38.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e64/274 (23.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e2.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.903-4.637\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 177px;\"\u003e\n \u003cp\u003eMale gender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e16/26 (61.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e157/274 (57.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e1.194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.529-2.696\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.663\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 177px;\"\u003e\n \u003cp\u003eASA II vs ASA I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e12/26 (46.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e97/274 (35.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e1.564\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.711-3.442\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.265\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 177px;\"\u003e\n \u003cp\u003eNeurological disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e8/26 (30.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e62/274 (22.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e1.514\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.633-3.619\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.350\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 177px;\"\u003e\n \u003cp\u003eRespiratory disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e11/26 (42.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e85/274 (31.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e1.634\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.736-3.628\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.227\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 177px;\"\u003e\n \u003cp\u003eCardiac disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e2/26 (7.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e8/274 (2.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e2.784\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.570-13.593\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.203\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 177px;\"\u003e\n \u003cp\u003eRecent URI (\u0026lt;15 days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e3/26 (11.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e6/274 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e5.821\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e1.377-24.600\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.017*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 177px;\"\u003e\n \u003cp\u003eDifficult intubation predicted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e2/26 (7.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e5/274 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e4.481\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.830-24.202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.081\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 177px;\"\u003e\n \u003cp\u003eCurrent URI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e2/26 (7.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e4/274 (1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e5.563\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.986-31.396\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 177px;\"\u003e\n \u003cp\u003eAltered consciousness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e2/26 (7.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e2/274 (0.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e11.333\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e1.531-83.948\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.017*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 177px;\"\u003e\n \u003cp\u003eRespiratory distress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e5/26 (19.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e8/274 (2.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e7.889\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e2.413-25.801\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 177px;\"\u003e\n \u003cp\u003ePreanesthetic consultation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e8/26 (30.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e152/274 (55.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.358\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.153-0.836\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.018*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 177px;\"\u003e\n \u003cp\u003eIV access\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e7/26 (26.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e81/274 (29.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.878\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.362-2.128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.771\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 177px;\"\u003e\n \u003cp\u003eProcedure duration \u0026gt;20 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e9/26 (34.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e89/274 (32.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e1.099\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.478-2.524\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.824\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eOR: odds ratio; CI: confidence interval; URI: upper respiratory infection; ASA: American Society of Anesthesiologists; IV: intravenous\u003c/em\u003e\u003cbr\u003e\u003cem\u003e* p \u0026lt; 0.05 statistically significant\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe strongest predictors in univariable analysis were: altered consciousness at presentation (OR = 11.333; 95% CI: 1.531-83.948; p = 0.017), respiratory distress (OR = 7.889; 95% CI: 2.413-25.801; p \u0026lt; 0.001), and recent upper respiratory infection within 15 days (OR = 5.821; 95% CI: 1.377-24.600; p = 0.017).\u003c/p\u003e\n\u003cp\u003ePreanesthetic consultation performed a few days before the procedure was associated with a significantly reduced risk of complications (OR = 0.358; 95% CI: 0.153-0.836; p = 0.018), suggesting a protective effect.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eMultivariable analysis\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eVariables with p-values \u0026lt; 0.20 in the univariable analysis were entered into the multivariable logistic regression model. Table 5 shows the results of the multivariable analysis after adjusting for potential confounders.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5. Multivariable Logistic Regression Analysis for Predictors of Complications\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"4\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted OR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRespiratory distress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.845\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.986-23.583\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.002*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRecent URI (\u0026lt;15 days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.921\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.042-23.230\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.044*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAltered consciousness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.124-74.123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.038*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePredicted difficult intubation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.842\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.632-23.357\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.145\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePreanesthetic consultation (protective)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.389\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.154-0.982\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.046*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eOR: odds ratio; CI: confidence interval; URI: upper respiratory infection\u003c/em\u003e\u003cbr\u003e\u003cem\u003e* p \u0026lt; 0.05 statistically significant\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAfter adjusting for confounders, four variables remained independently associated with complications. The most significant predictor was respiratory distress at presentation (aOR = 6.845; 95% CI: 1.986-23.583; p = 0.002), followed by altered consciousness (aOR = 9.127; 95% CI: 1.124-74.123; p = 0.038), and recent upper respiratory infection (aOR = 4.921; 95% CI: 1.042-23.230; p = 0.044).\u003c/p\u003e\n\u003cp\u003ePreanesthetic consultation remained a significant protective factor after adjustment (aOR = 0.389; 95% CI: 0.154-0.982; p = 0.046), indicating that proper preanesthetic evaluation reduced the risk of complications by approximately 61%.\u003c/p\u003e\n\u003cp\u003eThe multivariable model showed good discriminative ability (C-statistic = 0.782; 95% CI: 0.699-0.865) and adequate calibration (Hosmer-Lemeshow test: \u0026chi;\u0026sup2; = 6.824, p = 0.447).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical status and patient condition\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnalysis of patient clinical status revealed that critically ill children (defined as those with respiratory distress, altered consciousness, or ASA II classification with acute illness) had a significantly higher complication rate. Of the 26 patients with complications, 15 (57.7%) were classified as critically ill compared to 49 (17.9%) in the no-complications group (OR = 6.256; 95% CI: 2.723-14.372; p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcomes and recovery\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients eventually recovered and were discharged in stable condition. The one patient requiring ICU admission had convulsive emergence delirium and was discharged from ICU after 24 hours of observation without sequelae. No mortality was observed in this cohort.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis prospective observational study evaluated the incidence, nature, and predictors of complications during pediatric non-operating room anesthesia (NORA) and sedation procedures. Among 300 children managed in radiology and endoscopy units, the overall complication rate was 8.7% (95% CI 5.8\u0026ndash;12.4%). The majority of adverse events were respiratory in nature, followed by emergence agitation and cardiovascular instability. Several clinical predictors were identified, including respiratory distress, altered consciousness, and recent upper respiratory infection, while pre-anesthetic consultation emerged as a significant protective factor.\u003c/p\u003e\u003cdiv id=\"Sec26\" class=\"Section2\"\u003e\u003ch2\u003eIncidence and pattern of complications\u003c/h2\u003e\u003cp\u003eThe observed 8.7% incidence aligns with recent data from low- and middle-income countries (LMICs). Jarraya et al. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] reported an almost identical rate of 8.6% among 256 children under 5 years undergoing NORA in Tunisia, where respiratory compromise and inadequate pre-assessment were the main contributors. Similarly, Amin, N [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] found a 3.2% incidence in a larger multicentric Indian cohort of 3631 procedures. In contrast, studies from high-resource context, including large multicenter databases from the pediatric sedation research consoritium [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] have consstently demonstrated overall complication rates between 5 and 7%, with respiratory adverse events being the most frequent. These findings collectively confirm that pediatric NORA procedures particulary in radiology and endoscopic, carry a non negligible complication risks, mainly due to the challenge of airway management and environmental limitatios high-resource settings [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. These data collectively confirm that pediatric NORA procedures, particularly in radiology and endoscopy,carry a non-negligible complication risk, mainly due to the challenges of airway management and environmental limitations [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn our study, respiratory events accounted for 57.7% of all complications (5% of cases), consistent with other reports emphasizing that hypoxia, airway obstruction, and laryngospasm dominate pediatric NORA morbidity [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. studies, respiratory and airway issues comprise a large fraction of NORA complications. In Mongodi, S et al.\u0026rsquo;s MRI cohort, 50% of all adverse events were respiratory in nature (3.1% of cases), predominantly airway obstruction (53.5%) and laryngospasm (23.3%) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Similarly, Sirimontakan et al. observed that 3.9% of pediatric procedural sedations were complicated by respiratory events such as desaturation, laryngospasm, or apnea [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Even in large multicenter sedation registries, hypoxemia and airway compromise remain the most frequent adverse events. Cravero et al. reported that transient oxygen desaturation (SpO₂ \u0026lt; 90%) occurred in approximately 1.6% of sedations, while laryngospasm occurred in 0.043% of cases [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] The predominance of airway complications is multifactorial, reflecting both the anatomical and physiological susceptibility of children and the technical constraints inherent to remote, non-operating room environments.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec27\" class=\"Section2\"\u003e\u003ch2\u003ePredictors of complications\u003c/h2\u003e\u003cp\u003eYounger age and lower body weight were found to be significantly correlated with adverse perioperative outcomes, a relationship consistent with the findings of Ferrazzano et al. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], who observed that smaller and younger uncooperative children sedated with propofol for MRI exhibited a higher incidence of respiratory instability. Physiologically, immature respiratory control mechanisms, diminished functional residual capacity, and elevated oxygen consumption render infants particularly susceptible to hypoventilation and oxygen desaturation. In our study cohort, respiratory distress emerged as the most significant independent predictor of complications (aOR\u0026thinsp;=\u0026thinsp;6.845, p\u0026thinsp;=\u0026thinsp;.002), followed by altered consciousness (aOR\u0026thinsp;=\u0026thinsp;9.127, p\u0026thinsp;=\u0026thinsp;.038) and a recent upper respiratory infection (aOR\u0026thinsp;=\u0026thinsp;4.921, p\u0026thinsp;=\u0026thinsp;.044). These findings align with those of Jarraya et al. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], who identified pre-existing respiratory symptoms and neurological impairment as major determinants of adverse sedation events in pediatric non-operating room anesthesia (NORA). Similarly, Beach et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] demonstrated in a multicenter study that children with upper respiratory tract infections or airway hyperreactivity had significantly elevated rates of hypoxemia and laryngospasm during procedural sedation.\u003c/p\u003e\u003cp\u003eIn light of the substantial respiratory vulnerability associated with URIs, numerous expert reviews and specialty guidelines recommend postponing elective pediatric procedures for approximately two weeks after symptom resolution in cases of uncomplicated URIs [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. For complicated or severe infections, characterized by lower airway involvement, wheezing, respiratory distress, persistent cough or fever, or the presence of underlying pulmonary disease, several reviews advocate for a delay of at least four weeks, extending to four to six weeks in certain high-risk cases [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Furthermore, some investigations and scoring systems, such as the COLDS and COLDS-like risk assessment tools, suggest waiting at least 15 days (\u0026asymp;\u0026thinsp;2 weeks) for severe symptoms to subside; however, these frameworks emphasize the absence of universal consensus and recommend that postponement decisions be individualized according to symptom severity, comorbidities, and the inherent risk associated with the planned procedure [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec28\" class=\"Section2\"\u003e\u003ch2\u003eProtective role of pre-anesthetic consultation\u003c/h2\u003e\u003cp\u003eIn our prospective study, the pre-anesthetic consultation demonstrated a significant protective effect, reducing the likelihood of complications by 61% (aOR\u0026thinsp;=\u0026thinsp;0.389; p\u0026thinsp;=\u0026thinsp;0.046). This finding underscores the crucial role of systematic pre-procedure assessment in identifying comorbidities, anticipating airway challenges, and tailoring anesthetic management to individual patient needs. These results are consistent with those of Jarraya et al.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], who reported that the absence of a pre-anesthetic evaluation was independently associated with a higher incidence of peri-procedural complications in pediatric NORA cases. Likewise, Khan et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] in their scoping review on NORA safety events highlighted that structured pre-anesthetic screening and protocol standardization represent key strategies for minimizing adverse outcomes across diverse NORA environments. Collectively, the alignment between our findings and previous research reinforces the evidence that pre-anesthetic consultation serves as a critical safety measure, particularly in the paediatric population undergoing procedures outside the traditional operating-room environment.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec29\" class=\"Section2\"\u003e\u003ch2\u003eAnesthetic agents and procedural considerations\u003c/h2\u003e\u003cp\u003eIn our cohort, the inhalational agent sevoflurane was the most frequently used anesthetic\u0026mdash;consistent with prior paediatric NORA practices such as the ten-year MRI experience reported by Mongodi et al. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and others. Importantly, no specific anesthetic agent in our study emerged as an independent predictor of complications, which suggests that patient physiology and procedural context may outweigh pharmacologic choice in determining outcomes. This aligns with the findings of Amin et al., who studied 917 children and 3,631 NORA procedures and found an adverse-event incidence of 3.22% while identifying emergency status, anatomical site (abdomen/head-neck) and location (MRI/radiology suite) as the key predictors of morbidity rather than the anesthetic agent used [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Moreover, it is supported by Ferrazzano et al., who in a study of 109 uncooperative children undergoing NORA for dental treatment with propofol found a high success rate and minimal serious adverse effects, but identified intra-operative side-effects more strongly linked to age, health status and weight than to the drug itself [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Together, our findings and these prior studies reinforce that in paediatric NORA settings, procedural and patient-related factors, rather than specific anesthetic pharmacology, may drive safety outcomes, thereby underscoring the importance of pre-procedure planning, airway readiness, comorbidity optimisation and environment/logistics preparation.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eCritically ill status and outcomes\u003c/h3\u003e\n\u003cp\u003eChildren presenting with acute illness or critical physiologic instability (such as respiratory distress, altered consciousness, or an acute American Society of Anesthesiologists (ASA) II status) had a six-fold higher risk of complications in our prospective cohort (OR\u0026thinsp;=\u0026thinsp;6.256; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This observation echoes the findings of Incidence of complications after non‑operating room anesthesia in children in a low‑ and middle‑income country: A prospective and observational study by Jarraya et al. who identified critically-ill children (aOR\u0026thinsp;\u0026asymp;\u0026thinsp;2.49) and predicted difficult airway (aOR\u0026thinsp;\u0026asymp;\u0026thinsp;5.70) as independent predictors of adverse events [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough earlier study by Beach et al. did not show acute illness per se as a major independent predictor of major adverse events in a broader pediatric sedation data-set, their large sample emphasised that higher ASA status and urgency of procedure correlated with increased risk [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Despite the elevated risk in critically-ill children in our study, we observed no mortality, which likely reflects effective monitoring, prompt intervention and high-quality care by trained anaesthesia personnel, a reassuring indicator of institutional safety standards.\u003c/p\u003e\u003cdiv id=\"Sec31\" class=\"Section2\"\u003e\u003ch2\u003eClinical implications\u003c/h2\u003e\u003cp\u003eThese findings underscore the importance of pre-anesthetic evaluation, patient optimization, and vigilant monitoring in all paediatric NORA procedures. Children with recent respiratory infections or neurological compromise should be considered high-risk, and their procedures should only be undertaken in settings with immediate access to airway-rescue equipment and adequate recovery facilities. The literature supports this: in their scoping review of NORA safety events, A Scoping Review on the Incidence of Nonoperating Room Anesthesia Safety Events emphasised the need for standardised definitions, structured screening, and protocol standardisation to minimise adverse events [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eLikewise, Anaesthetic practices in non‑operating room settings for paediatric patients: A prospective observational study identified emergency status, anatomical site and procedural location as key predictors of morbidity in paediatric NORA, and emphasised that targeted protocols and staffing are necessary [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn addition, narrative reviews discussing NORA safety highlight the remote-location risks and call for mandatory checklists, team training, and consistent monitoring equivalent to OR standards [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCollectively, these data suggest that standardisation of NORA protocols, including mandatory pre-assessment, procedure-specific checklists, and post-sedation observation, are essential to minimise variability and enhance safety in paediatric non-operating room anesthesia.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec32\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThis single-center study has inherent limitations regarding generalizability. The sample size, although adequate for statistical modeling, remains modest compared with multicentric registries. Moreover, long-term outcomes were not evaluated, and subtle complications such as delayed desaturation or neurobehavioral effects may have been underestimated. Nevertheless, the prospective design, standardized data collection, and use of objective complication criteria lend robustness to these findings.\u003c/p\u003e\u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis prospective analysis identified a complication rate of 8.7% in pediatric non-operating room anesthesia, predominantly respiratory in nature. The most powerful predictors of complications were respiratory distress, altered consciousness, and recent upper respiratory infection, whereas pre-anesthetic consultation significantly reduced risk. These results, in harmony with recent international evidence, highlight the critical value of systematic pre-anesthesia assessment for procedural preparedness and multidisciplinary coordination in improving safety for pediatric NORA patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDISCLOSURE AND FUNDING STATEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Mohammed V Military Teaching Hospital (protocol code HMV-2024-045, approval date 2024). Written informed consent was obtained from the parents or legal guardians of all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONFLICTS OF INTEREST\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical use of AI tools:\u0026nbsp;\u003c/strong\u003eWe declare that AI-assisted tools were used in the literature research and drafting phases of this manuscript. All content was fully reviewed, edited and verified by the authors, who take full responsibility for the integrity, originality, and accuracy of the data and conclusions. Ethical guidelines for AI use in academic writing were followed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDATA AVAILABILITY STATEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUTHOR CONTRIBUTIONS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization, H.K. and M.B.; Methodology, H.K.; Validation, H.K., K.A. and M.B.; Formal Analysis, H.K.; Investigation, H.K., K.A., A.H., E.H., A.E., H.B.; Data Curation, H.K.; Writing – Original Draft Preparation, H.K.; Writing – Review \u0026amp; Editing, H.K., M.B.; Supervision, M.B.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eACKNOWLEDGMENTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the medical and nursing staff of the Radiology and Endoscopy Departments of Mohammed V Military Teaching Hospital for their valuable cooperation during data collection.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBell, C., \u0026amp; Sequeira, P. M. (2005). Nonoperating room anesthesia for children. Current opinion in anaesthesiology, 18(3), 271\u0026ndash;276. https://doi.org/10.1097/01.aco.0000169234.06433.48\u003c/li\u003e\n\u003cli\u003eKaye, A. D., Rogers, B. N., Mashaw, S., Mosieri, C. N., Urman, R. D., \u0026amp; Shekoohi, S. (2025). Safety of nonoperating room anesthesia: a narrative review. Current opinion in anaesthesiology, 38(4), 425\u0026ndash;434. https://doi.org/10.1097/ACO.0000000000001542\u003c/li\u003e\n\u003cli\u003eYoun, A. M., Ko, Y. K., \u0026amp; Kim, Y. H. (2015). Anesthesia and sedation outside of the operating room. Korean journal of anesthesiology, 68(4), 323\u0026ndash;331. https://doi.org/10.4097/kjae.2015.68.4.323\u003c/li\u003e\n\u003cli\u003eMaddirala, S., \u0026amp; Theagrajan, A. (2019). Non-operating room anaesthesia in children. Indian journal of anaesthesia, 63(9), 754\u0026ndash;762. https://doi.org/10.4103/ija.IJA_486_19\u003c/li\u003e\n\u003cli\u003eAmin, N., Patil, P., \u0026amp; Sanapala, V. (2025). Anaesthetic practices in non-operating room settings for paediatric patients: A prospective observational study. Indian journal of anaesthesia, 69(5), 502\u0026ndash;508. https://doi.org/10.4103/ija.ija_1057_24\u003c/li\u003e\n\u003cli\u003eJarraya, A., Kammoun, M., Khcharem, J., Ch\u0026eacute;rif, O., Feki, W., \u0026amp; Mnif, Z. (2024). Incidence of complications after nonoperating room anesthesia in children in a low- and middle-income country: A prospective and observational study. \u003cem\u003ePediatric Anesthesia\u003c/em\u003e, 34(9), 856-863. https://doi.org/10.1111/pan.14955\u003c/li\u003e\n\u003cli\u003eKamat, P. P., McCracken, C. E., Gillespie, S. E., Fortenberry, J. D., Stockwell, J. A., Cravero, J. P., \u0026amp; Hebbar, K. B. (2015). Pediatric critical care physician-administered procedural sedation using propofol: a report from the Pediatric Sedation Research Consortium Database. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 16(1), 11\u0026ndash;20. https://doi.org/10.1097/PCC.0000000000000273\u003c/li\u003e\n\u003cli\u003eCravero, J. P., Beach, M. L., Blike, G. T., Gallagher, S. M., Hertzog, J. H., \u0026amp; Pediatric Sedation Research Consortium (2009). The incidence and nature of adverse events during pediatric sedation/anesthesia with propofol for procedures outside the operating room: a report from the Pediatric Sedation Research Consortium. Anesthesia and analgesia, 108(3), 795\u0026ndash;804. https://doi.org/10.1213/ane.0b013e31818fc334\u003c/li\u003e\n\u003cli\u003eCravero, J. P., Blike, G. T., Beach, M., Gallagher, S. M., Hertzog, J. H., Havidich, J. E., Gelman, B., \u0026amp; Pediatric Sedation Research Consortium (2006). Incidence and nature of adverse events during pediatric sedation/anesthesia for procedures outside the operating room: report from the Pediatric Sedation Research Consortium. Pediatrics, 118(3), 1087\u0026ndash;1096. https://doi.org/10.1542/peds.2006-0313\u003c/li\u003e\n\u003cli\u003eHavidich, J. E., \u0026amp; Cravero, J. P. (2012). The current status of procedural sedation for pediatric patients in out-of-operating room locations. Current opinion in anaesthesiology, 25(4), 453\u0026ndash;460. https://doi.org/10.1097/ACO.0b013e32835562d8\u003c/li\u003e\n\u003cli\u003eFerrazzano, G. F., Cantile, T., Quaraniello, M., Iannuzzi, M., Palumbo, D., Servillo, G., Caruso, S., Fiasca, F., \u0026amp; Ingenito, A. (2021). Effectiveness and Safety of Intravenous Sedation with Propofol in Non-Operating Room Anesthesia (NORA) for Dental Treatment in Uncooperative Paediatric Patients. Children (Basel, Switzerland), 8(8), 648. https://doi.org/10.3390/children8080648\u003c/li\u003e\n\u003cli\u003eMongodi, S., Ottonello, G., Viggiano, R. et al. Ten-year experience with standardized non-operating room anesthesia with Sevoflurane for MRI in children affected by neuropsychiatric disorders. BMC Anesthesiol 19, 235 (2019). https://doi.org/10.1186/s12871-019-0897-1\u003c/li\u003e\n\u003cli\u003eSirimontakan T, Artprom N, Anantasit N. Efficacy and Safety of Pediatric Procedural Sedation Outside the Operating Room.Anesth Pain Med.2020;10(4):e106493.https://doi.org/10.5812/aapm.106493.\u003c/li\u003e\n\u003cli\u003eBeach, M. L., Cohen, D. M., Gallagher, S. M., \u0026amp; Cravero, J. P. (2016). Major Adverse Events and Relationship to Nil per Os Status in Pediatric Sedation/Anesthesia Outside the Operating Room: A Report of the Pediatric Sedation Research Consortium. 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Consensus Recommendations for the Safe Conduct of Nonoperating Room Anesthesia: A Meeting Report From the 2022 Stoelting Conference of the Anesthesia Patient Safety Foundation. Anesthesia and analgesia, 137(2), e8\u0026ndash;e11. https://doi.org/10.1213/ANE.0000000000006539\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Non-operating room anesthesia, pediatric anesthesia, complications, risk factors, sedation, patient safety","lastPublishedDoi":"10.21203/rs.3.rs-7923178/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7923178/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eNon-operating room anesthesia (NORA) is increasingly utilized in pediatric practice, but complications remain a concern, particularly in resource-limited settings.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo determine the incidence of complications during pediatric NORA and identify associated risk factors.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis prospective observational study included 300 children undergoing sedation or anesthesia for diagnostic and therapeutic procedures in radiology and endoscopy departments of a university hospital. Demographics, medical history, procedural details, and complications were recorded. Univariable and multivariable logistic regression analyses were performed to identify independent risk factors.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe overall complication rate was 8.7% (26/300). Respiratory complications were most frequent (57.7%), followed by emergence agitation (30.8%). Independent risk factors included respiratory distress (adjusted OR\u0026thinsp;=\u0026thinsp;6.845; 95% CI: 1.986\u0026ndash;23.583; p\u0026thinsp;=\u0026thinsp;0.002), altered consciousness (aOR\u0026thinsp;=\u0026thinsp;9.127; 95% CI: 1.124\u0026ndash;74.123; p\u0026thinsp;=\u0026thinsp;0.038), and recent upper respiratory infection (aOR\u0026thinsp;=\u0026thinsp;4.921; 95% CI: 1.042\u0026ndash;23.230; p\u0026thinsp;=\u0026thinsp;0.044). Preanesthetic consultation was protective (aOR\u0026thinsp;=\u0026thinsp;0.389; 95% CI: 0.154\u0026ndash;0.982; p\u0026thinsp;=\u0026thinsp;0.046). No mortality occurred.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eComplications during pediatric NORA remain significant. Careful patient selection, thorough preanesthetic evaluation, and awareness of risk factors can improve safety. Systematic preanesthetic consultation should be implemented for all pediatric NORA procedures.\u003c/p\u003e","manuscriptTitle":"Incidence and risk factors of complications after non-operating room anesthesia in children: a prospective observational study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-02 16:44:42","doi":"10.21203/rs.3.rs-7923178/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"36294444-95f2-4e65-8d46-6374f017ebbd","owner":[],"postedDate":"December 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-04T06:08:29+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-02 16:44:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7923178","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7923178","identity":"rs-7923178","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}