Applying enhanced recovery after surgery principles to the nonoperating room anesthesia environment: rationale, current evidence, and future directions

PURPOSE OF REVIEW: Enhanced recovery after surgery (ERAS) has evolved into a well established, evidence-based framework for perioperative care in numerous surgical disciplines. At the same time, advances in minimally invasive and catheter-based techniques have substantially expanded the number and complexity of procedures performed outside the operating room, leading to a rapid growth of nonoperating room anesthesia (NORA). Despite the clear overlap between ERAS principles and NORA patient needs, comprehensive recovery concepts for interventional procedures remain limited. RECENT FINDINGS: Current evidence on ERAS-based approaches in NORA is sparse and heterogeneous, mainly originating from gastroenterology, cardiology, and interventional radiology. Existing studies suggest that selected enhanced recovery principles are feasible in interventional care and may improve patient comfort, recovery, safety, and procedural efficiency. However, implementation is often fragmented and lacks standardized, pathway-based peri-interventional management. SUMMARY: Enhanced recovery principles hold substantial potential to improve peri-interventional care within the rapidly expanding NORA environment. The critical gap is not the absence of ERAS elements, but the absence of structured peri-interventional recovery governance comparable to established surgical ERAS pathways. Future progress will require holistic, multidisciplinary recovery frameworks, standardized concepts with procedure-specific adaptations, and clinical and economic evidence. Given its central role across the peri-interventional continuum, anesthesiology is well positioned to contribute to and potentially lead the development of structured enhanced recovery pathways beyond the operating room.