Retrospective study of anaesthesia management of paediatric patients for ct mri

Introduction – With the development of new technology CTMRI procedures have become very common and routine investigation for perfect diagnosis and management of patient. A typical MRI takes 30 to 40 min. and it is very important to keep patient absolutely immobile for this period.
Issues for the anaesthesiologist are:
1. Head and torso of patient remains in MRI machine and are unavailable for airway management.
2. Loud banging noise makes patient claustrophobic.
3. Remote location of MRI machines for safety reasons, so comfort ness and availability of expert help and resuscitative methods are not accessible.
4. Patients are taken on an emergency basis routine preoperative checkups and preparation are compromised.
5. Patients for MRI are usually with cerebral palsy, newborn babies with congenital, neurological and cardiac defect. Including TPGA Transposition of great arteries, hydrocephalous Meningocoele, ASD, VSD all these patients will be very high risk for general anaesthesia or even for sedation as ASA GRADE 3 OR GRADE 4 RISK.
6. Ferromagnetism causes iron or any other metal item to get attracted towards machine can cause dangerous complication including death.
Methodology – Our institute is equipped with MRI compatible anaesthesia machines and monitors we have studied requirement of anaesthesia and sedation in 100 patients from 1 month old to less than 12 years old. Study was conducted over period of 1 year and methods used were:
1. Pedichloryl 40-50 mg /kg body wt orally
2. inj. Fortwin and Midazolam in whom only sedation failed
3. complete general anaesthsia in ASA grade III or ASA grade IV , in patients were above methods failed and in patients when duration was more than 2 to 3 hours Anaesthetic induction agents were required mainly Ketamine and Propofol Older children with proper counselling were managed mainly by sedation method.
Patients were observed for adverse events like airway obstruction with hypoxia, immobility, hypothermia, and these complications were mainly present in only sedated patient, and with higher ASA grade status
Conclusion – Proper counselling of patient, taking care to avoid claustrophobia, preventing hypothermia with proper wrapping of patient, especially neonates, will make MRI successful in most of patient’s cases .patients with higher ASA status, or critically ill were better managed with proper general anaesthsia with ETT or LMA.