Anesthetic concerns for pediatric patients in an intraoperative MRI suite

Intraoperative magnetic resonance imaging (iMRI) is an evolving technology used to provide precise intraoperative navigation during a variety of neurosurgical and other types of surgical procedures. Anesthesiologists need to be aware of the unique challenges created by this environment. Failure to recognize the differences between the diagnostic MRI environment and the iMRI environment can compromise the safety of the patient and operating room staff and present logistical problems. Recent surgical reports herald the uses and benefits of iMRI. However, there are a few in the anesthesia literature addressing the significant benefits and the anesthesia-specific issues this technology creates. We will review recent reports describing anesthetic care of patients in this environment as well as examine the recent surgical and radiologic literature as they relate to issues faced by anesthesiologists. We describe the design of different iMRI suites as well as provide a breakdown of both patient and equipment issues encountered by anesthesiologists practicing in this environment. Finally, we offer our ongoing experience in this environment and provide suggestions to optimize patient outcomes.