Increased risk of general anesthesia for high-risk patients undergoing magnetic resonance imaging.
OBJECTIVE
The aim of this study was to review mortality rate pertinent to anesthesia in magnetic resonance imaging (MRI) settings and compare it with operating room (OR) mortality rate.


METHODS
A total of 47,389 anesthetics have been administered to pediatric patients in the Montefiore Medical Center between February 1998 and September 2007, of which 11,700 (25%) were administered for procedures performed outside the OR. Our data collection system allows us to separate outside OR locations into 2 separate groups. One group includes MRI, computed tomography scan, and radiology, and the other includes gastrointestinal procedures, hematology-oncology, and all others. The data we present show the total number of cases, and demographic numbers reflect the total numbers as well.


RESULTS
On the basis of the 3 deaths from general anesthesia occurring in the MRI suite, the resulting non-OR mortality rate at our institution was approximately 1 in 3900. Comparatively, in the same period, our mortality rate for procedures performed intraoperatively under general anesthesia was 1 in 7138. Therefore, there is almost a 2-fold increased risk in mortality associated with non-OR versus OR anesthetics at our institution.


CONCLUSIONS
Our analysis shows that the administration of anesthesia in MRI suite possesses inherent risks that might be the same or even higher than those in the OR.


BACKGROUND
Over the last 2 decades, the scope of anesthesia practice has expanded to include remote sites away from the operating room. As the number of diagnostic and therapeutic interventions performed outside the operating room continues to increase, anesthesiologists are being faced with challenges of providing care for more medically complex patients while adapting to fewer resources, with lack of support system commonly available in the operating room. In this article, we present three pediatric cases resulting in poor outcomes, all of which occurred in our MRI suite.
Department of Anesthesiology, Metropolitan Hospital Medical Center, New York, NY 100129, USA. m_girshin@yahoo.com
Michael
M
Girshin
Victoria
V
Shapiro
Amanda
A
Rhee
Sanford
S
Ginsberg
Mario A
MA
Inchiosa
D000015:Abnormalities, Multiple / Q000175:diagnosis / Q000401:mortality*; D061085:Agenesis of Corpus Callosum; D000768:Anesthesia, General / Q000401:mortality*; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis; D006801:Humans; D007223:Infant; D055092:Laryngomalacia / Q000175:diagnosis; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D009519:New York City / Q000453:epidemiology; D009873:Operating Rooms / Q000706:statistics & numerical data*; D018570:Risk Assessment; D015996:Survival Rate; D055090:Tracheomalacia / Q000175:diagnosis; D014683:Vena Cava, Superior / Q000002:abnormalities