Safe Anesthesia in Magnetic Resonance (MR) Units Clinical Practice Guidelines (2019)

Association of Anaesthetists of Great Britain and Ireland (AAGBI)/Neuro Anaesthesia and Critical Care Society of Great Britain and Ireland (NACCSGBI)

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

February 26, 2019

The guidelines on safe provision of anesthesia in magnetic resonance (MR) units were released on February 3, 2019, by the Association of Anaesthetists of Great Britain and Ireland (AAGBI) and the Neuro Anaesthesia and Critical Care Society of Great Britain and Ireland (NACCSGBI).[1]

Service Organization and Training

All hospitals providing a service for anesthesia within the MR unit should have a lead anesthetist who is responsible for providing anesthesia for magnetic resonance imaging (MRI).

Training should be provided for all grades of anesthetists delivering anesthesia in this remote area; all anesthetists should have an understanding of the hazards involved in anesthetizing a patient in the MR unit.

Anesthesia/sedation for patients who need an MRI scan, including intensive care unit (ICU) patients, should take into account each patient's pathophysiologic status and the remote location of the MRI unit.

Whenever possible, anesthesia in remote sites should be provided by appropriately experienced consultants.

When care is delegated to a trainee or a Specialty and Associate Specialist (SAS) doctor, such a care provider should have the appropriate competencies and level of training.

It is not acceptable for inexperienced staff members who are unfamiliar with the MR environment to manage a patient in this environment, particularly outside standard hours.

Patients must be accompanied to the scanner by appropriately trained staff members. If an anesthetic machine is being used, the anesthetist should be supported throughout by an anesthetic assistant who is suitably skilled, appropriately trained, and familiar with the anesthetic requirements.

Patient and Staff Safety

All patients and staff must be screened for the presence of implants and devices that may be contraindications for safe scanning. The referring team should discuss the safety of the devices with the MR-responsible person and the anesthetist to plan a suitable management strategy.

Anyone remaining in the scanning room should be provided with ear protection during scanning.

MRI should be undertaken only if the diagnostic benefit outweighs the risk. This discussion must involve the multidisciplinary team, particularly for a patient in the ICU.

MR safety checklists for general anesthesia, intraoperative MRI, and transfer of ICU patients should be used in conjunction with the World Health Organization (WHO) checklist.

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