1. Dr Fernandez-Bustamante, Dr Steven Zeichner
Anesthesia in MRI room
Dr Fernandez-Bustamante, Dr Steven Zeichner
Steven Bourland, CA-3
Joe Morabito, CA-2
Joel Roberts, CA-1

2. Near Miss
75 M with history of stroke, paraplegia, HTN, hyponatremia on fluid restriction presents for MRI of brain-C-T-L-S spine. Decision made for GETA given length of scan. Five minutes after induction the pulse oximeter loses signal.
Patient removed from scanner and brought into Zone III, 2mg phenylephrine, 500mcg epi, 2L volume patient’s vitals stabilized.
Upon review, no transport monitor so no Arterial BP monitoring available
No additional IV fluid in drug cart
Initially only succinylcholine in drug cart, no Roc
No LMAs in cart

3. Understanding the problem
MRI room often understocked by pharmacy and anesthesia techs due to lack of access
Only MRI tech and anesthesia code badge can access MRI
Anesthesia providers not familiar with providing care within MRI room
Confusion about where to resuscitate patient if needed
How to use MRI monitors, infusion pumps
General confusion about supplies available in MRI room
There is a code cart available
There is not a transport monitor available within MRI room

4. Root cause analysis: Fishbone
Individual Factors: familiarity with MRI room, equipment/monitors/where to resuscitate if needed
Task Factors: Inform each team specifically of current problems, Residents new to MRI (NORA) need education on room setup/work-flow
Team Factors: important for all team members to understand potential pitfalls of anesthetics in MRI
Education Training: bringing awareness to current problems, Re-education of all involved teams

5. RCA: Fishbone cont.
Communication: amongst anesthesia/pharmacy/MRI techs will ensure anesthetics can safely be provided in MRI room
Equipment resources: Anesthesia/Pharmacy techs often forego MRI supplying if MRI tech not present, MRI infusion pumps not always functioning
Working Conditions: MRI is isolated and help not as readily available, need to have access to emergency meds/airway equipment/monitoring without calling someone

6. Methods Evaluate current MRI knowledge of anesthesia providers
15 question pre-test via survey monkey
Provide education worksheet with subsequent post-test

7. Knowledge Survey
56 UCH Anesthesia providers polled about common MRI anesthetic problems
Average Score 62%
Lowest Score 20%
Median 67%
Highest Score 93%
Standard Deviation 17%

8. Education
Only 25% providers knew to move patient from Zone IV to Zone III for resuscitation

9. Education
54% of providers incorrectly thought an anesthesia ventilator is always present within MRI room
52% of providers know how to get vitals to crossover into epic with MRI compatible monitors
72% of providers agreed a transport monitor should be readily available in MRI
Post-test scores were dramatically improved after education document reviewed, average score of 85%
Pre-test avg 67%

10. Room for improvement
Continued education to anesthesia staff about differences within MRI room, importance of checking room for supplies needed for anesthetic plan/back-up plan
Coordination between pharmacy, anesthesia techs, and MRI tech to ensure access
Leave a transport monitor within the MRI control room
Should residents on NORA receive an information sheet along with their objectives on these common MRI pitfalls
Should an anesthesia ventilator always be present within MRI?

11. References
“Practice Advisory on Anesthetic Care for Magnetic Resonance Imaging: An Updated Report by the American Society of Anesthesiologist Task Force on Anesthetic Care for Magnetic Resonance Imaging” Anesthesiology, V122, No 3. March 2015