Anaesthetic concerns for patients undergoing neurosurgical procedures utilising intra-operative magnetic resonance imaging

Abstract

Intra-operative magnetic resonance imaging (ioMRI) is an evolving technology that offers precise intra-cranial lesion localisation and intraoperative navigation by combining the high-resolution imaging capabilities of MRI with an operative suite. Developed in the 1990s, ioMRI presents caregivers with a variety of unique challenges revolving around performing surgical procedures in an operating theatre with a high-strength magnetic field. Different types of ioMRI systems exist, differentiated by the relative mobility of the patient and magnet. As with any MRI environment, safety is of paramount concern. Published safety guidelines exist from both the American College of Radiology and the American Society of Anesthesiologists. A variety of checklists can be used to enhance the safety of the ioMRI suite. There are a variety of anaesthetic considerations when caring for patients in this environment including concerns related to the anaesthesia equipment, the patient and the general MRI environment. A multidisciplinary approach can encourage safety and efficiency in this unique operating room. The purpose of this review is to discuss the variety of topics that anaesthesiologists need to consider using this technology, including the indications, specific equipment considerations and unique safety aspects of caring for patients in the ioMRI suite. While performing surgery in a high-strength magnetic field environment carries its own special risks, each type of ioMRI suite presents its own unique challenges to patient safety. Although the challenges are significant, safe care and optimal outcomes are certainly possible with appropriate understanding of the factors unique to the ioMRI environment, good communication, a collaborative approach and proper procedural planning. © TOUCH MEDICAL MEDIA 2013.