围术期磁共振成像神经外科麻醉的安全问题

Safety consideratrion of neurosurgery anesthesia for intraoperative magnetic resonance imaging

目的结合133例进行围术期磁共振成像的神经外科手术患者处理体会，初步探讨该类手术的安全问题。方法观察在术中磁共振成像手术室（iMRI—OR）进行术前、术中扫描及术后进入检查室进行扫描的患者，记录围术期与扫描相关的安全问题。结果所有患者顺利完成了术前、术中及术后扫描，未发生与围术期扫描相关的意外及并发症。结论围术期磁共振成像安全问题至关重要，其顺利进行需要团队成员的通力合作，麻醉医生的首要职责是保障患者围术期的安全平稳，严格的安全防范措施及细致的工作制度必不可少。

Objective To discuss the safety issues related to intraoperative magnetic resonance imaging （iMRI） in neurosurgical anesthesia. Methods We observed neurosurgery patients undergone MRI scanning in iMRI operation room preoperatively , intraoperatively and in diagnostic room shortly after operation between February to July in 2009. All patients were investigated for MRI contraindication preoperatively. The doctors and nurses participated in the procedure were trained strictly. The patients finished MRI scanning with general anesthesia. With the support of MRI - compatible machines （ anesthetic machine, monitor, infusion pumps）, safety issues related to scanning were recorded. Results All patients finished the MRI scanning safely, including 120 cases undergone intraoperative scanning （the average scannig times was 1.7 rain） and 13 cases undergone postoperatively seannig. Patients remained stable during scanning. There was remarkably strong interference on electrocardiogram （ECC） in static MRI field and different scanning sequences, such as ECG baseline changed, multiphasie ST - segment alterations and ＂ severe arrhythmia＂, moreover the vital signs were stable. All anasthetic procedures were performed successfully, and the instruments were running well. There was no MRI -scanning releated complication. Conclusions During iMRI scanning, the safety considerations are important which need team -working. Anaesthetists play an important role to guarantee the patients safety. Safety precautions and vigilance are necessary.