The incorporation of MRI technology into the operating theatre brings additional challenges. A variety of drugs are useful for sedation and a clear understanding of the pharmacokinetic and pharmacodynamic effects of the individual agent is vital when choosing the most appropriate drug for a particular patient/scenario. –Anesthesia Students –Physician’s Assistants –CRNP’s –Floor Nurses ... MRI Zones •All MRI suites have designated “zones” to ensure safety ... –“Condition A or C in Magnetic Resonance Imaging (MRI) In the event of a crisis in MRI, it is For example, the gradient fields can be manipulated, such that increased local water diffusion further attenuates the received RF signal. These can occasionally cause mild side-effects, including nausea, vomiting, and pain on injection, and there is a recognized, albeit low, incidence of anaphylactoid reactions. RF heating also creates a risk of severe and rapid burns from any conductive material left on the patient's skin, so contact with the metal in clothing, RF coils, ECG leads, and other equipment must be avoided. Medical MRI scanners apply limits on gradient field manipulation to avoid the more extreme consequences of induced currents such as limb movement or ventricular fibrillation. Capnography is complicated by the use of long sampling lines and an increase in the time delay (up to 20 s) of the displayed waveform. Owing to the noisy, claustrophobic environment of the MRI scanner, and the need to minimize movement for enhanced image quality, deep sedation is needed for the duration of the scan. The successful use of iMRI during neurosurgery has been reported in tumour surgery [ventricular tumours, gliomas (particularly low grade), and difficult pituitary tumours], epilepsy surgery including the placement of depth electrodes, and deep brain stimulation surgery.9 Other uses of iMRI include the biopsy of the liver and breast lesions that allows for accurate and early diagnosis. )2 MR compatible anaesthetic machines and ventilators can be sited adjacent to the magnet bore, minimizing the length of the breathing system and allowing for the safe delivery of volatile anaesthesia. Alternatively, if total intravenous anesthesia is used, it should be administered by using: (1) MRI safe/conditional pumps in zone IV, (2) traditional (i.e., MRI unsafe) pumps in zone III with intravenous tubing passed through a wave guide, or (3) periodic bolus injections in either zone III or IV. In many cases, particularly for longer scans or particular patient groups, general anaesthesia is required (Table 1). There are multiple setups of monitoring devices for the pt from room to room (i.e., induction room, transportation, MRI suite). Continuing Education in Anaesthesia Critical Care & Pain, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust. It is used extensively for imaging the central nervous, musculoskeletal, and cardiovascular systems, and also the pelvis and liver. conceptual zones around the MRI scanner. Ugan Reddy, BSc FRCA, Mark J White, MPhys PhD, Sally R Wilson, BSc FRCA, Anaesthesia for magnetic resonance imaging, Continuing Education in Anaesthesia Critical Care & Pain, Volume 12, Issue 3, June 2012, Pages 140–144, https://doi.org/10.1093/bjaceaccp/mks002. T1-weighting provides good grey–white matter contrast on brain images and T2-weighting identifies tissue oedema clearly. Patients cannot be seen because they are generally enveloped by the MRI machine (although remote visualization should be employed, if available). They have a cylindrical-bore design with the static field maintained by a superconducting solenoid within a dewar of liquid helium. Often the anesthetic can be delivered allowing the patient to breathe … Pens, bobby pins, hairclips, etc. The zones are listed below: • Zone I: This region includes all areas that are freely accessible to the general public. For MRI exams requiring anesthesia, a verbal timeout with the participation of all staff members assigned to the patient must occur to include the completion of the MRI Safety: Pre Anesthesia Timeout … Prolonged operating times, repeated intraoperative scans, difficult intraoperative thermoregulation, and meticulous attention to patient positioning on the operating table and during the transfer into the scanner bring additional challenges.8 Both total i.v. Visit Tell Your Patients. 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