Intraoperative MRI for neurosurgical and general surgical interventions

Abstract

IMRI is becoming increasingly more popular, especially with neurosurgeons, but its use is also expanding to other types of surgeries. Because of the increased use, the anesthesia provider must be aware of the dangers that it imposes to those involved and take necessary safety precautions. This will help assure that no one is harmed during the operation or procedure.

Anesthetic challenges and outcomes for procedures in the intraoperative magnetic resonance imaging suite: A systematic review

“…The included manuscripts mainly consisted of informal (non-systematic) reviews (n=10) [2][3][4][5][6][25][26][27][28][29], institutional experiences (n=10) [30][31][32][33][34][35][36][37][38][39], and case series/retrospective studies (n=12) [40][41][42][43][44][45][46][47][48][49][50][51], with only a few prospective studies (n=4) [52][53][54][55]. We also included 11 references that were published only in abstract form [56][57][58][59][60][61] or case report format [62][63][64][65][66].…”

“…In addition, many authors commented on the distance between the patient and the location of the anesthesia team and equipment, resulting in a need for extensions for the intravascular lines, breathing circuit, and gas sampling line [2-4, 6, 25, 26, 28, 30, 33-35, 37-39, 46, 49, 51, 55, 59, 61, 63, 66]. Several authors agreed that the increase in extensions and dead space can cause delays in intravenous or inhalational drug administration and recognition of a malfunction such as disconnection or obstruction of tubing, which is further compounded by the inability to readily assess the airway or vascular access sites during the procedure [2,3,5,6,26,38,39,51,55]. Exclusion criteria for patients deemed ineligible for iMRI environment were also commonly discussed.…”

“…A few authors specifically commented on the unfamiliarity of the iMRI suite or distractions, including the noise burden [3,6,26,29,33,34,38,39,45,46,55,61,63,64,65]. Several demanded extra personnel, either as a designated safety person or to assist with airway/patient management during crisis due to the limited access to the patient and long distance from the anesthesia equipment [2,5,26,31,32,38,50,55,60]. The immediate availability of emergency equipment and a "safe" space or induction room without the restrictions of the iMRI room, were other commonly articulated concerns [3, 28, 31, 37-39, 44-46, 49, 50, 66].…”

“…Anesthesia care in a magnetic resonance imaging (MRI) environment poses unique challenges that are well described [1]. However, little evidence exists specific to MRI-guided surgical procedures, although several narrative review articles discuss far-reaching implications for anesthetic care [2][3][4][5][6]. Intraoperative MRI (iMRI) technology has steadily gained acceptance since its inception at the Brigham and Women's Hospital in Boston, MA, in the early 1990s [7].…”

Safety Management for MR-Guided Interventions

“…All MR-Unsafe equipment must have clear marking to avoid any risks. Anesthesiology care also is the important question in case of intraoperative MRI (10). For vital functions monitoring and support a hospital needs to have the MRcompatible anesthesiology equipment (special ventilator, infusion pumps, pulse oximeters, catheters, needles etc.)…”