Is it difficult to cooperate with MRI examination? Anesthesiologist can help you

Have you ever had an MRI? Do you know what it feels like to have an MRI?

My father had an MRI for lumbar disc herniation. I curiously asked him how he felt during the examination. My father described it this way: "Before the examination, the doctor gave me a cotton ball and asked me to plug my ears and close my eyes to relax. After the examination began, there was noise in the small and claustrophobic space. Out of curiosity, I opened my eyes. It was like a space capsule, very closed and a little scary. I closed my eyes and continued to hear all kinds of hissing and thumping sounds. My eyebrows were unconsciously locked and twitching. I just wanted it to be over quickly."

MRI in the eyes of doctors↑ VS MRI in the eyes of patients↓

It is difficult for awake adults to undergo MRI examinations, and it is even more difficult for special patients to complete the examination. What should we do in this case? Don't worry, the anesthesiologist is here to help~

Why do some MRI examinations require anesthesia and sedation by an anesthesiologist?

Nuclear magnetic resonance imaging (NMRI), also known as magnetic resonance imaging (MRI for short), uses the principle of nuclear magnetic resonance to draw images of the internal structure of an object. This technology is used to image the internal structure of the human body and has become a revolutionary medical imaging technology diagnostic tool. Compared with ordinary X-rays and computerized tomography (CT), MRI images are very clear and detailed, and can better locate and characterize lesions. It is of great value in the diagnosis of diseases of all systems in the body, especially the diagnosis of early tumors, and has greatly improved the diagnostic efficiency of doctors.

Although MRI is accurate in diagnosis, it also has certain shortcomings, such as the examination is conducted in a relatively closed space, the examination time is long, the operation of the MRI machine makes noise, and due to the strong magnetic field, it is not suitable for special patients such as those with magnetic metal or pacemakers in their bodies. In addition, there are certain requirements for the degree of patient cooperation, such as requiring the patient to remain still for a long time. Therefore, when encountering patients who cannot cooperate with the examination, anesthesiologists are required to implement anesthesia and sedation to assist in completing the examination, which can also be called anesthesia MRI.

What kind of patients need anesthesia and sedation by an anesthesiologist during MRI examination?

Generally, an MRI examination is required, otherwise the diagnosis cannot be accurately confirmed. However, patients who cannot cooperate with the examination due to illness or personal factors need to undergo anesthesia MRI, including:

(1) Children who are uncooperative, crying, or making a fuss;

(2) Patients who are afraid, terrified, or uncooperative;

(3) Patients with special diseases: such as patients with epilepsy, ADHD, Parkinson's disease, etc. whose body shaking affects the image quality, patients with unclear consciousness and agitation, and patients in a passive position due to muscle contracture, pain, etc. caused by special diseases;

(4) Patients with psychological or mental illnesses: claustrophobia, mental disorders;

(5) Patients with hyperacusis.

How is anesthesia performed during MRI examination? Will it cause adverse effects to the patient/child?

Anesthesia MRI generally uses intravenous anesthetics for sedation. Midazolam, propofol, dexmedetomidine and other intravenous anesthetics need to be used according to the patient's condition, weight, etc. For patients whose examination time is expected to be longer, anticholinergic drugs can be used to prevent excessive secretions from affecting ventilation and prevent complications such as airway spasm.

You can rest assured that MRI under anesthesia is safe. First of all, anesthesiologists are well-trained and experienced physicians; secondly, strict anesthesia consultation is required before MRI under anesthesia. If the patient has upper respiratory tract infection, fever, diarrhea, severe cardiopulmonary disease, sleep apnea syndrome, gastrointestinal obstructive disease, etc., MRI under anesthesia cannot be performed.

In addition, the anesthesiologist will select drugs and dosages according to the patient's/child's different conditions, status, weight, etc., and monitor vital signs during the examination. Finally, anesthesia MRI is strictly carried out in accordance with the anesthesia process. After anesthesia, there is a dedicated person to take care of it. Only after reaching the awakening standard can it be safely returned to the ward for continued monitoring.

What special requirements does the particularity of MRI examination sites impose on the implementation of anesthesia?

Due to the strong static magnetic field in the MRI room, patients, family members and medical staff are strictly prohibited from bringing ferromagnetic materials into the MRI room. In addition, all instruments in the MRI room are dedicated, otherwise it may cause interference, damage, abnormal imaging, etc. of the MRI machine. In such a special environment, anesthesia can be performed outside the MRI room and then the patient is transferred to the MRI room; or anesthesia can be performed indoors using non-ferromagnetic, non-metallic anesthesia equipment.

Although conventional anesthesia monitors, anesthesia instruments and emergency equipment cannot enter the MRI room, they can be monitored outside the MRI room by connecting long wires. If necessary, the anesthesiologist will immediately transfer the patient to the room for emergency treatment.

Why is it necessary to monitor vital signs during MRI examination under anesthesia?
In order to protect the life safety of patients, patients undergoing MRI examinations under anesthesia must monitor their vital signs. In case of abnormal conditions, the anesthesiologist must deal with them as soon as possible. Due to the special conditions of the MRI room, ordinary monitoring instruments cannot enter the MRI room, and anesthesiologists often observe patients outside the MRI room through lead glass. However, abnormalities such as the patient's breathing, chest rise and fall, and lip color are not easy to detect, so relevant instruments must be used to monitor vital signs, such as pneumatic breathing fluctuation sensors and special anti-magnetic pulse rate monitors. Ordinary life monitors with long wires can also be used to monitor patients' vital signs outside the MRI room.

How is the current status of anesthesia MRI examination outside the operating room?

Anesthesia MRI examination outside the operating room is a comfortable medical project. Some patients who are afraid of MRI noise or cannot stand being still for a long time can also undergo a comfortable MRI examination under anesthesia and sedation. It can be said that with the participation of anesthesiologists, MRI can not only help patients get diagnosed and treated as soon as possible, but also allow patients to enjoy comfortable diagnosis and treatment services, providing patients with a new examination experience.

Although MRI under anesthesia has many advantages, the current development of anesthesia MRI is not satisfactory due to problems such as slow examination efficiency, high examination costs, shortage of anesthesiologists, and insufficient understanding of anesthesia MRI by doctors of other disciplines and patients.

According to statistics, there are not many hospitals that really carry out anesthesia MRI in first-tier cities like Beijing. In recent years, the Department of Anesthesiology of Sanbo Brain Hospital of Capital Medical University has done a lot of work in this regard, formulated detailed anesthesia examination procedures and systems, and carried out hundreds of anesthesia MRI examinations every year, solving the problems for patients who cannot undergo MRI normally.