Anesthetic considerations for neurosurgery using intraoperative magnetic resonance imaging

This article reviews issues confronted by anesthesiologists in operating rooms equipped with magnetic resonance imaging devices (iMRI). The organizational aspects of anesthetic care delivery in the iMRI, training of personnel, planning for emergencies, and acquisition and maintenance of MR-compatible anesthetic and monitoring equipment are outlined. Potential problems with patient monitoring in the iMRI are described and possible solutions are suggested. We discuss patient selection and management problems that are specific to the MR environment-access to the patient, providing care in a remote location, and dealing with emergencies in a relatively isolated environment. Alterations in anesthetic techniques that are appropriate in the iMRI are described for conscious sedation/neuroleptanalgesia and for general anesthesia. Options for the anesthetic care of patients that present particular challenges in the iMRI-patients with anticipated difficulties in airway management and patients with myocardial ischemia-are reviewed. The delivery of anesthetic care in an iMRI requires teamwork, planning, and vigilance. When attention is paid to the limitations introduced by iMRI, provision of care has minimal effect on perioperative anesthetic outcome.