Procedure specific agents, such as those required to manipulate coagulation, intracranial pressure or arterial blood pressure, should be available.
Interventional vascular radiology may involve treating unstable patients with severe haemorrhage. Such patients may include those with significant gastrointestinal bleeding or patients with post partum haemorrhage.40 Equipment to deal with these patients should be immediately available. This includes that necessary to introduce and monitor a variety of intravascular catheters, rapid infusion devices, blood and fluid warming devices and patient warming devices.
The hospital’s protocol for major haemorrhage should be available and periodically rehearsed.
Remote monitoring of the patient with slave screens should be available to allow the anaesthetic team to monitor the patient from outside of the magnetic field.
Particular consideration should be given to the problems of using infusion pumps. All non-essential pumps and equipment should be removed from the patient before entering the magnetic field. MRI compatible infusion pumps should be available wherever anaesthesia is provided regularly. Infusions with extra-long giving sets can be used when MRI-specific pumps are not available.43
All staff involved with transferring a patient to the MRI scanner should understand the unique problems caused by monitoring and anaesthetic equipment in this environment.44 It is not acceptable for inexperienced staff unfamiliar with the MR environment to escort or manage a patient in this environment, particularly out of hours.42
The patient and all staff should have an MRI safety and exclusion questionnaire completed before entering the magnetic field.
In the event of an adverse incident in the MRI scanning room, the patient should be removed from the scanning room without delay; immediate access to an anaesthetic preparation room or resuscitation area is essential.2
Anaesthesia provided for electroconvulsive therapy (ECT) is frequently performed in remote locations. Ideally, a consultant or suitably experienced SAS doctor should provide general anaesthesia; the guidance provided for anaesthetic provision in remote sites should be followed.44
