#JustIn: 2019 Guidelines for safe provision of anaesthesia i
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There is an increase in the number of units providing anaesthesia for magnetic resonance imaging (MRI) and in the type of intervention performed within the MR environment.

The present guidelines, released by the Association of Anaesthetists and the Neuro Anaesthesia and Critical Care Society of Great Britain and Ireland, are intended to inform and advise anaesthetists, as well as the multidisciplinary team, about safety aspects and best practice relating to anaesthesia within the MR environment. The guidelines have been published in the journal Anesthesia

The first Association of Anaesthetists guideline on provision of anaesthetic services in MR units was published in 2002, with an update on safety in MR units published in 2010. These guidelines include new material on several topics including revised terminology, changes to the number and type of implants and devices that can be scanned, different layouts of interventional scanning units, and the types of surgery or intervention that can now be performed within the MR suite.

Service organisation and training
1. All hospitals providing a service for anaesthesia within the MR unit should have a lead anaesthetist responsible for provision of anaesthesia for MRI.

2. Training should be provided for all grades of anaesthetist delivering anaesthesia in this remote area; all anaesthetists should have an understanding of the hazards involved in anaesthetising a patient in the MRI unit.

3. Anaesthesia/sedation for a patient needing an MRI scan, including intensive care unit (ICU) patients, should take into account the patient's pathophysiological status and the remote location of the MRI unit.

4. Whenever possible, anaesthesia in remote sites should be provided by appropriately experienced consultants.

5. When care is delegated to a trainee or Specialty and Associate Specialist (SAS) doctor, they should have the appropriate competencies and level of training.

6. It is not acceptable for inexperienced staff, unfamiliar with the MR environment, to manage a patient in this environment, particularly out‐of‐hours.

7. Patients must be accompanied to the scanner by appropriately trained staff members, and if an anaesthetic machine is being used, then the anaesthetist should be supported throughout by an anaesthetic assistant who should be suitably skilled, trained and familiar with the anaesthetic requirements.

Patient and staff safety
8. All patients and staff must be screened for the presence of implants and devices that may be a contraindication to a safe scan. The referring team should discuss the safety of the devices with the MR Responsible Person and the anaesthetist to plan a suitable management strategy.

9. Anyone remaining in the scanning room should be provided with ear protection during scanning.

10. The MRI for patients should only be undertaken if the diagnostic benefit outweighs the risk. This discussion must involve the multidisciplinary team, particularly for a patient on the ICU.

11. The MR safety checklists for general anaesthesia, intra‐operative MRI and for transfer of ICU patients should be used in conjunction with the World Health Organization (WHO) checklist.

Note: This list is a brief compilation of some of the key points included in the guidelines and is not exhaustive and does not constitute medical advice. Kindly refer to the original publication here: https://onlinelibrary.wiley.com/doi/full/10.1111/anae.14578
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