- Remoteness of location and lack of trained personnel to assist in the event of an emergency
- Unfamiliarity with different equipment or specialized monitors
- At the end of the procedure, patients generally travel greater than usual distance to the PACU
- Immediate contacts with centrally located team when help is needed
- Adequate monitoring capability, ability to deliver supplemental oxygen, suction, equipment for mechanical ventilation, supply of drugs, scavenging capability
- Protection if radiation being used
- Backup equipment, personnel, and appropriate monitoring for transport
- Intensity decreases with inverse square of the distance from emitting source
- Always wear a lead apron, thyroid shield, and remain 1–2 m from source
- Monthly radiation exposure not to exceed 50 mSv per FDA guidelines, as measured by radiation badges
- Used for the sake of patient immobility and to minimize pain and anxiety
- Generally not necessary for adult patients, but for children and adults who cannot remain motionless (anxious, mentally retarded, demented, etc.)
- Either sedation or general anesthesia can be used
- Primary concern is airway management and maintenance of adequate oxygenation
- Comorbidities should be taken into consideration with special attention to airway as access is often limited
- Conscious sedation with continuous propofol infusions often used successfully
- Oversedation can lead to hypoventilation and airway obstruction, so ETT or LMA preferred by many
- Dexmedetomidine is often used, especially in patients likely to obstruct and become apneic, or those who require frequent assessment of mental status
Strength of the magnetic field of MRI unit ranges from 0.5 to 1.5 Tesla
- Any ferrous-containing material may be drawn to magnet, often with lethal force (missile injury). It can injure patients or others in the room
- Pacemakers, ICDs, cochlear implants, orthopedic hardware, cerebrovascular clips also at risk of dislodgement, hemorrhage, or injury to adjacent vulnerable structures
- Magnetic metals (nickel, cobalt) most magnetic and dangerous while aluminum, titanium, copper, silver are not dangerous
- Alternative (MRI compatible) equipment and monitors
- Radiofrequency energy produced by scanner can be absorbed by tissue, producing heat that can cause tissue damage
- Loud sound (65–95 dB) generated, which can cause hearing loss; patients should wear ear plugs
- Extremely important as direct visualization is limited
- Should be placed at least 5–8 feet from the magnet bore to minimize magnetic pull
- EKG is often distorted by the radiofrequency energy and static magnetic field
- Monitoring sites, for example ECG pad sites, at risk for heating from the magnetic field, which can burn patients
- Electronic monitors can themselves generate radiofrequency waves that interfere with quality of MRI image
- MRI compatible fiber optic pulse oximeter should be used as standard oximeters can cause burns
- Radiofrequency pulsing can generate artificial spikes and generate erroneously high blood pressures on invasive blood pressure monitoring
- Remove patient from MRI suite, call for backup, and initiate resuscitation at a different anesthesia station (that should be located right outside)
- If necessary, shut off ...
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