Anesthesia and Airway Management in the MRI Suite (original) (raw)

Anesthesia-compatible Magnetic Resonance Imaging

2020

1 Although we agree with their conclusion that human error related to magnetic resonance imaging (MRI) use can only be minimized by adequate training, we believe lessening the risks of MRI technology itself is of equal importance. We feel it is time to stress the importance of "anesthesia-compatible" MRI, rather than putting all the emphasis on anesthesiologists adapting to the needs of the MRI machine. Anesthesiologists and patients are now forced into working under conditions that are far less than optimal in MRI suites that are cold and dark, have noisy equipment and facilities, and are often located far away from the main operating area. There are three aspects of MRI that are important to the anesthesiologist: 1) avoidance of materials and equipment that will be attracted to the MRI machine, 2) avoidance of anesthetic devices that interfere with the function of the MRI machine, and 3) avoidance of MRI interference with the patient and the functioning of materials and ...

Anesthetic management and human factors in the intraoperative MRI environment

Current Opinion in Anaesthesiology, 2016

Purpose of review The use of intraoperative MRI technology during neurosurgery has become increasingly more common over the past several years. These surgical procedures require a specialized operating room designed to accommodate an MRI machine, as well as MRI-compatible anesthesia equipment and monitors. The MRI environment also poses unique risks and challenges to both patients and medical staff. Recent findings General anesthesia in the MRI operating room suite poses several challenges not routinely experienced in a conventional operating room suite, and anesthesia providers delivering care in these suites must complete specialized training and screening. The presence of a magnetic field, as well as reduced access to the patient during the MRI scan, require high levels of vigilance.

MRI of Central Nervous System under General Anaesthesia with Laryngeal Mask Airway in Childhood

Rivista di neuroradiologia, 2004

Our anaesthetic experience and outcomes in children undergoing magnetic resonance imaging (MRI) scanning are presented. unpremedicated 417 children were included in this study. Heart rate (HR), noninvasive blood pressure (BP) and peripheral oxygen saturation (SpO 2) were monitored by MRI-compatible equipment during MRI scanning in all children. Induction of anaesthesia was performed with 4-8% sevoflurane inhalation in 50% nitrous oxide-oxygen mixture using Mapleson D breathing circuit by an MRI-compatible anaesthesia machine. After providing regular spontaneous ventilation, an appropriate sized classic laryngeal mask airway (LMA) was positioned. Then anaesthesia and ventilation were maintained with approximately 1-1.5% sevoflurane inhalation in 50% nitrous oxide oxygen mixture using the circle system. MRI studies of all the children were completed successfully with satisfactory image quality. HR, BP and SpO 2 remained within safe limits throughout MRI scanning. Vomiting was observed in 22 children out of 417 which resolved spontaneously without any antiemetic therapy. Oral intake was established within 20 minutes of anaesthesia completion in children. All of the children were discharged within 1 hour after admission to the postanaesthesia care unit. In conclusion, LMA used under general anaesthesia in children undergoing MRI scanning was uneventful allowing satisfactory image quality and prompt discharge of children with far fewer complications resulting from general anaesthesia. ÖZET-Manyetik rezonans (MR) uygulanacak çocuklardaki anestezi deneyimlerimizi ve sonuçlarımızı sunduk. Bu çalışmaya 417 premedikasyonsuz çocuk dahil edildi. Kalp atım hızı (KAH), non invazif kan basıncı (KB) ve periferik oksijen saturasyonu (SpO 2) MR uyumlu anestezi ekipmanıyla monitorize edildi. Anestezi indüksiyonu MR uyumlu anestezi cihazıyla Mapleson-D solunum devresi kullanılarak %50 azot-oksijen içinde %4-8 sevofluran inhalasyonu ile gerçekleştirildi. Düzenli spontan solunum sag landıktan sonra uygun büyüklükteki laringeal havayolu yerleştirildi ve sonra anestezi ve ventilasyon halka sistemi kullanılarak %50 azot-oksijen karışımı içinde %1-1.5 sevofluran inhalasyonu ile sag landı. Çocukların tümünde tatminkar MR görüntüleri elde edildi. KAH, KB ve SpO 2 MR sırasında emniyetli sınırlar içinde kaldı. 417 olgudan 22'sinde antiemetik terapi gerektirmeyen spontan düzelen kusma gözlendi. Oral alım o anestezi tamamlanmasından sonra 20 dk içinde başlandı. Çocuklar ayılma odasına alındıktan sonra 1 saat içinde taburcu edildiler. Sonuçta MR uygulanacak çocuklarda laringeal havayolu kullanılarak genel anestezi uygulaması tatminkar kalitede görüntüler elde edilmesine ve hızlı hasta taburculug una olanak vererek ve genel anesteziden kaynaklanan çok az komplikasyonla sorunsuz tamamlandı.

Claustrophobia and premature termination of magnetic resonance imaging examinations

Journal of Magnetic Resonance Imaging, 2007

Purpose: To evaluate the incidence of MRI-related claustrophobia and prematurely terminated MRI (ptMRI) examinations due to claustrophobia in a large-scale cohort study. Materials and Methods: The hospital's computerized radiology information system (RIS) was retrospectively analyzed for all 1.5-Tesla MRI examinations and reports during the year 2004. Data collected included demographic information, body part examined, known claustrophobia, and whether the examination was prematurely terminated. All information available on the MRI examinations and the patient-based data (i.e., excluding any additional examinations per patient) were analyzed. Results: A total of 5798 MRI reports of 4821 patients were evaluated. A total of 95 patients (1.97%) suffered from claustrophobia and 59 (1.22%) prematurely terminated the examination due to claustrophobia. The incidence of ptMRI was higher in women than men (no statistical significance). The majority of patients with ptMRI were between 20 and 80 years old. Patients undergoing head MRI showed the highest incidence of ptMRI and those undergoing extremity, breast, or pelvic MRI had the lowest. Prone compared to supine positioning results in the lowest ptMRI incidence (P Ͻ 0.05). Conclusion: Claustrophobic reactions cause a relatively low incidence of ptMRI and are influenced by sex, body part examined, and positioning within the MR scanner. Sedation and prone positioning might help overcome these reactions.

Strategies to cope claustrophobia during magnetic resonance imaging examination

International Journal of Research in Medical Sciences

Background: Claustrophobia associated with MRI scan is a well-recognized problem all over the world. The unpleasant psychological experience during MRI can lead to premature cancellation of the study resulting in non-interpretable data. In addition, performing future studies on the claustrophobic patient may not be possible leading to non-utilization of an important diagnostic modality. This study was conducted with the aim to determine a cheap and short intervention which can be applicable to small radiology set up as well.Methods: A prospective study was conducted at a tertiary care hospital from October 2016 to December 2016. Accompanying someone was the first strategy used to coped MR imaging claustrophobia followed by placebo (multivitamin), listening Quran and closed eye (blindfold). All those patients who failed to respond in these strategies were finally labeled as an unsuccessful candidate. Listening of Quran was selected as one of the tools as all the patients were Muslims...

Another cause of difficulty in ventilating a patient

Journal of Clinical Anesthesia, 2003

Various mechanical problems with the delivery of anesthesia gases have been reported, and preoperative checks of the anesthesia delivery system are designed to prevent these. We report a case of a mechanical obstruction of the expiratory limb of the anesthesia circuit which went undetected before the induction of anesthesia. A check of the circuit was performed before the addition of circuit extensions, thus missing the obstruction. Systematic investigation of the anesthetic system after difficulty in ventilating the patient revealed the obstruction, without any harmful consequence to the patient. This case highlights the importance of a thorough check of the system before any anesthetic, particularly after any change in the circuit.

Three difficult airway management strategies in the same patient at three different times

Anaesthesia, Pain & Intensive Care, 2020

Unpredictable difficult intubation is a commonly faced clinical issue and one of the most important reasons of morbidity related to anesthesia. We present a case of a 50 y old, 100 kg, 1.8 m tall (BMI=37) male patient, taken to OR (transoral robotic) for a planned biopsy because of a mass in his larynx. Videolaryngoscope was used two times but still intubation was unsuccessful.