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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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- 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 ...