This chapter will focus on what is historically and currently known from the published literature about healthcare leadership, leadership theories, and styles. Additional discussions will further describe the complex operating room (OR) suite environment, challenges inherent to an OR leadership position, physician leadership, organizational culture, and conflict resolution strategies.

As healthcare and technology progress, the need for anesthesia services escalates both in and out of the operating room (OR). Due to a high volume of cases needing sedation, many non-anesthesiologists are providing this service. Non-anesthesiologists who administer sedation must realize that sedation and general anesthesia are on a continuum. Individuals who are performing deep sedation must demonstrate the ability to recognize that a patient has entered a state of general anesthesia and be able to maintain a patient’s vital functions until the patient has been returned to an appropriate level of sedation. A thorough pre-procedure evaluation must be completed, and monitoring of the patient’s oxygenation, ventilation, circulation, and level of consciousness must be assessed at regular intervals. Understanding the pharmacologic profiles of common medications is a necessity including medications such as benzodiazepines and opioids. Newer agents such as fospropofol and remimazolam are gaining popularity and practitioners should be aware of these novel agents. Institutions should have specific processes for credentialing and training of practitioners who administer sedation for procedures as well as quality improvement protocols and risk assessments to ensure patient safety.

Operating rooms are a key revenue driver for hospitals, making it imperative that they are managed correctly. Anesthesiologists are uniquely positioned to lead and manage operating rooms given their knowledge and understanding of different surgical cases both in and out of the operating room; yet resident education and training on the intricacies of running an operating room and managing workflows is lacking. A resident lecture series that focuses on the business aspects of running operating rooms, understanding bottlenecks, and updates on the newest technologies to assist with scheduling and staffing can help prepare the next generation of OR leaders and managers.

Today, there are an increasing number of procedures requiring moderate and deep sedation being performed outside the surgical suite. As a result, qualified non-anesthesia providers are administering varying levels of sedation to patients for a variety of diagnostic, therapeutic, and/or surgical procedures. Practitioners should provide patients with the benefits of sedation and/or analgesia while minimizing the associated risks. To do so, providers should understand the pharmacology of the agents being administered as well as the role of pharmacologic antagonists for opioids and benzodiazepines. Today’s practitioners are equipped with an abundance of versatile sedative agents that can be used alone and in combination. Furthermore, combinations of sedative and analgesics should be administered as appropriate for the procedure being performed and the condition of the patient. Policies and standards regarding administration of sedation and analgesia by non-anesthesia providers are addressed elsewhere in the book. This chapter focuses on the pharmacology of the drugs most used to provide moderate and deep sedation and their available reversal agents.