Anaes · Perioperative medicine
Anaesthesia in remote sites and the MRI environment
Also known as MRI anaesthesia · Remote site anaesthesia standards · MRI zones safety · Ferromagnetic projectile risk · Non-operating room anaesthesia MRI
Exam-exhaustive remote-site and MRI anaesthesia: organisational standards equal to the OR, MRI Zones I–IV, ferromagnetic projectile risk, implant labelling, MRI-conditional monitoring, quench response, and practical GA/sedation logistics for ANZCA Final and equivalents.
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Red flags
- The magnet is ALWAYS on — ferromagnetic objects in Zone IV become projectiles.
- Remote site ≠ lower standard: same monitoring, trained help, oxygen failure plan, and resuscitation equipment as the OR.
- Unscreened staff or equipment entering Zone III/IV is a never-event pathway.
- Quench: helium asphyxiation risk — evacuate, do not enter fog without oxygen plan, follow local quench protocol.
- Standard infusion pumps, steel oxygen cylinders, and ordinary laryngoscopes may be unsafe — only MRI-conditional equipment in the magnet room.
Meet the patient
A four-year-old needs a magnetic resonance imaging brain scan under general anaesthesia in a 3-tesla scanner. She cannot keep still awake, her parents are anxious, and the scanner is two corridors and a locked door from the nearest arrest trolley. The anaesthetic machine in the magnet room is a conditional one, and the cylinders on the transfer trolley are the standard steel kind.[1]
The two questions that frame the whole list are the two that frame every remote-site anaesthetic: can I deliver operating-theatre safety here? and what in this room can kill us? A magnet that is always on turns ordinary theatre equipment into projectiles, and a child whose head sits in the bore is a child whose airway is two minutes away.[1][2]
References3ShowHide
- [1]Wilson SR, Shinde S, Appleby I, et al. Guidelines for the safe provision of anaesthesia in magnetic resonance units 2019: Guidelines from the Association of Anaesthetists and the Neuro Anaesthesia and Critical Care Society of Great Britain and Ireland Anaesthesia, 2019.PMID 30714123
- [2]Kanal E, Barkovich AJ, Bell C, et al. ACR guidance document on MR safe practices: 2013 J Magn Reson Imaging, 2013.PMID 23345200
- [3]Greenberg TD, Hoff MN, Gilk TB, et al. ACR guidance document on MR safe practices: Updates and critical information 2019 J Magn Reson Imaging, 2020.PMID 31355502