Patients’ cardiovascular function may be impaired, and they may need airway maintenance and ventilatory assistance.Īccording to the guidelines of the American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists, ( 22) non-anesthesiologists who perform sedation and analgesia in a variety of settings must be able to rescue patients from any level of sedation, because the sedation may become deeper than initially intended. General anesthesia is the drug-induced loss of consciousness during which patients cannot be aroused. In this state of consciousness, cardiovascular function is usually maintained, but ventilatory function may be impaired therefore, patients may require assistance in maintaining a patent airway. In this state, cardiovascular function and spontaneous ventilation are not impaired.ĭeep sedation/analgesia is the drug-induced depression of consciousness during which patients cannot be easily aroused, but will respond to painful stimulation. Moderate sedation/analgesia (conscious sedation) is the drug-induced depression of consciousness during which patients respond purposefully to spoken commands. In this state, patients’ cognitive function and co-ordination may be impaired, but cardiovascular and ventilatory functions are unaffected. Minimal sedation (anxiolysis) is drug-induced sedation during which patients respond normally to spoken commands. The guideline describes 3 levels of sedation and general anesthesia as follows: The American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists developed practice guidelines ( 22) for sedation and analgesia by non-anesthesiologists. It is also necessary to have various non-magnetic devices and accessories available for emergencies including an oxygen cylinder, laryngoscope, aspirator and other emergency equipment that is appropriate for the MRI environment. However, various physiologic monitors have been developed for use in an MRI environment. Because of the strong magnetic field generated by the MRI-thousands of times greater than that of the earth’s magnetic field-any items in the MRI environment that contain ferrous materials become potential dangerous projectiles that could injure the patient. Also, it is well recognized that injured or critically ill patients can sustain central nervous system or cardiopulmonary complications and should be carefully monitored during the MRI procedure.Ĭonventional monitoring equipment and accessories are not designed to operate in an MRI environment. Guidelines issued by the Joint Commission on Accreditation of Healthcare Organizations indicate that patients who receive sedatives or anesthesia require monitoring during the administration and recovery from these medications. ( 7) This information indicates that all patients who are sedated for MRI procedures should be physiologically monitored and supported by the appropriate means. The Safety Committee of the Society for Magnetic Resonance Imaging has published guidelines and recommendations concerning the monitoring of patients during MRI procedures. With the use of sedation and anesthesia, it is necessary to monitor cardiorespiratory parameters during the procedure and to provide an equivalent standard of care as that provided in the operating room. Patients under sedation may become unable to respond or alert the MRI technologist about respiratory problems, cardiac distress or other changes in physiological status. ( 3– 6) Of greatest concern is the risk of respiratory depression and hypoxemia that potentially have long-term effects.

The MRI procedure poses little risk to the patient, but investigators have highlighted the risk of life-threatening adverse events related to sedation of children or adults for diagnostic procedures. ( 1, 2) Patients’ lack of immobility and distress contribute to adverse health outcomes, compromise the quality of images and decrease the efficiency of the imaging facility due to delayed or cancelled examinations. Several studies have shown that 14% to 20% of adult patients require sedation to tolerate MRI. Some adult patients who undergo an MRI procedure experience emotional distress that can range from mild anxiety to a full-blown panic attack. Many children either have difficulty remaining immobile during the MRI procedure or become frightened by the MRI equipment. MRI investigations are lengthy therefore, many patients, particularly children, cannot tolerate the procedure without sedation or general anesthesia. The wider availability and increasing use of MRI equipment, however, has led to a number of problems. In the past few years, the indications to perform MRI have increased markedly.

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