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There should be locally agreed protocols and pathways for the provision of anaesthetic services in MRI both in and out of hours.

Anaesthetic equipment that is used in the MRI room should be MR safe or conditional.^5,67

Remote monitoring of the patient with a secondary screen in the control room 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. MR safe or conditional infusion pumps or the use of a protective MR capsule for standard pumps should be available wherever anaesthesia is provided regularly. Infusions with extra-long giving sets can be...

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. 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.^65,66,68

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 and immediate access to an anaesthetic preparation room or resuscitation area is required.⁵

Anaesthesia for ECT is frequently performed in remote locations. Ideally, a consultant or an autonomously practising anaesthetist (see Glossary) should provide general anaesthesia. Appropriately trained recovery and operating department staff should be provided, and the guidance provided for anaesthetic provision in remote sites should be followed.⁶⁹

The ECT clinic should adhere to the ECT Accreditation Service (ECTAS) or Scottish ECT Accreditation Network (SEAN) standards for administration of ECT and have been assessed and accredited by ECTAS or SEAN.⁶⁹

There should be a clinical lead (see Glossary) for ECT who is responsible for provision of the service in each anaesthetic department. The named consultant should be responsible for determining the optimal location for provision of anaesthesia for patients of American Society of Anesthesiologists classification III or above. Contingency plans for transfer to an acute care facility should also...