“Low-field” intraoperative MRI: a new scenario, a new adaptation

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].…”

“…Seventeen manuscripts reported data on adverse events from a total of 2520 cases, which can be further divided into the following broad categories: adverse anesthesia or clinical events (reported in 12 manuscripts, including a total of 1955 cases) [40][41][42][43][44][45][46]53,[55][56][57][58], MRI-related adverse events (reported in 7 manuscripts, including a total of 889 cases) [42,43,[46][47][48]57,59], or technical problems (reported in 5 manuscripts, including a total of 535 cases) [47][48][49]51,53]. We did not examine surgical adverse outcomes or complications, even though those were addressed in some of the included manuscripts, because our research question focused on anesthetic considerations.…”

“…On the one hand, "no adverse anesthesia events" were reported in 5 manuscripts. On the other hand, one author reported an adverse event in 100% of cases [55], using a broad definition that included inability to use the usual equipment and interference with monitoring. Monitoring difficulty was specifically noted in 4 manuscripts, and ranged from 4%, when "monitor dysfunctions" were encountered, to 100%, when electrocardiogram (ECG) interference was counted as adverse event.…”

“…Fifteen manuscripts addressed the surgical or case duration of procedures with iMRI (see Table 5) [40,42,43,[46][47][48][49][50][51][53][54][55][56][57][58]. Several definitions for those time periods were considered in the different studies as summarized in Table 5.…”

“…Aside from detailing specifics of anesthetic care in the iMRI setting, many authors noted safety concerns specific to the iMRI environment: There was wide agreement regarding the need for safety protocols and ferromagnetic object counts prior to moving the iMRI machine to the patient or transferring the patient into the scanner [3-6, 26-29, 32, 33, 36, 38, 43, 45, 55, 59-62]. Several manuscripts described a risk for dislodgment or disconnection of an airway or vascular access devices, typically associated with transfer into the scanner or from vibrations caused by the scanning process [2,4,6,28,33,38,39,44,46,53,55,62,64]. Another commonly voiced concern was that the available MRI-compatible physiologic monitors have limitations in their functionality [2-6, 25-29, 32-39, 43-47, 49, 51, 53,55, 57, 59, 61, 64, 66]: electrocardiogram artifacts and poor ST segment monitoring ability were consistently reported, as was lack of MRI-safe temperature monitoring in earlier references.…”