Intraoperative magnetic resonance imaging in neurosurgery and anesthetic considerations

作     者：Nidhi Gupta Girija Prasad Rath 

作者机构：Unit of Neuroanaesthesia Fortis Memorial Research Institute Department of Neuroanaesthesiology Neurosciences Centre 

出 版 物：《World Journal of Anesthesiology》 (世界麻醉学杂志)

年 卷 期：2014年第3卷第2期

页      面：174-180页

学科分类：10[医学] 

主　　题：Intraoperative magnetic resonance imaging Electromagnetic field Safety Anesthesia Neurosurgery 

摘      要：Currently, magnetic resonance imaging(MRI) is the only imaging modality available which is capable of acquiring intra-operative images frequently with acceptable spatial and contrast resolution. However, the incorporation of MRI technology into the operating room requires special anesthetic considerations. It may include various aspects such as transport, remote location anesthesia, strong electromagnetic field, use of approved items, equipment counts, possible emergencies, and surgery in awake patients. The patient safety may be compromised by health-related, equipment-related, and procedure-related risks. Direct patient observation may be compromised by acoustic noise, darkened environment, obstructed line of sight, and distractions along with difficult access to the patient for airway management. Most often, the patient s head will be 180° away from the anesthesiologist during the procedure. Several monitors exist that are designed for conditional use in a MR environment. The general design criterion in these monitors is to eliminate conductors that carry electrical signals for monitoring physiologic parameters of the patient. General anesthesia requires an extended anesthetic circuit for ventilation maintenance and drug administration because the patient is located farther from the anesthesia machine than in traditional operating room settings. Dead space creates a time delay before the volatile anesthetic and drugs are administered and when expected effects can be observed. Therefore, the attending anaesthesiologists must understand the above aspects for safe conduct of neurosurgical procedures by minimizing MRI associated accidents while assuring optimal patient vigilance.