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  • 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

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  • 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

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  • 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

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  • 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

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Strength of the magnetic field of MRI unit ranges from 0.5 to 1.5 Tesla

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Hazards of MRI

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  • 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

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  • 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

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  • 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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