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elderly pt with CHB and PPM, lung CA with mets. Needs MRI. You are called to provide sedation for claustrophobia. How do you proceed or do you proceed?
Have at it.
Have at it.
elderly pt with CHB and PPM, lung CA with mets. Needs MRI. You are called to provide sedation for claustrophobia. How do you proceed or do you proceed?
Have at it.
Doesn't the pacer disqualify this patient from an MRI?.
Why do an MRI? We already know this guy has Lung Ca with mets. What information can the MRI tell us that a CT can't? QUOTE]
I agree with you from a prognostic standpoint.
On top of that, how would this information change our long term management of a guy who has a poor prognosis anyway?
As an anesthesiologist, would this be your reply if the primary team asked for your opinion on whether you can provide anesthesia for their patient?
PPM = permanent pacemaker
The question is whether to do an MRI on a patient whose life depends on a relatively delicate piece of electronics inside implanted metallic object.
My instinct is that there isn't any MRI finding that could meaningfully alter this guys outcome.
Doesn't the pacer disqualify this patient from an MRI?
Assuming it didn't matter, and assuming there are no other 'issues' I would load precedex and run a drip. Or just a low dose propofol infusion with a few boluses.
1st CHB= complete heart block? PPM=?
I am seeing more and more requests for this situation. ie where the patient is has multiple potential life threatening comorbities for an otherwise simple procedure. Although my altruistic side says they are calling us because they want the patient to have the best and safest sedation, my critical sides says that we are merely assuming liability for the medicine or radiology guy.
I would ask them how the study is going to change their management of the patient. Then i would ask them what there expectations are. If they want a GA w/o an airway in an MRI i would be more critical. Does the pt have a pacer?
On a side note i was once asked to provide sedation for an MRI for a patient with acute mental status changes and they were considering that patient may being having a CVA. I asked the ED physician who placed the consult if neurology felt comfortable with deep sedation in a patient with an unknown cerebral event. Neurology was not and the ed cancelled the consult.
Cant put a swan in the MRI either. If it is absolutely essential (which it most likely isnt) that he needs an MRI, the pacer needs to be interrogated to see
1. Is he pacemaker dependent. Just because he was in complete block when it was put in doesnt mean he is now.
2. What happens when I put a magnet on it. Not that it really matters in this case since my magnet is going nowhere near the MRI which will probably mess up the pacer programming anyway.
If he actually isnt pacer dependent and needs the MRI, then deactivate the pacer do the MRI with whatever sedation works for you, and keep the crash cart with pacing pads close by. tell the MRI folks they may need to abort quickly. If not tell them to go to CT or PET for whatever they need the scan for.
by the way, some abbreviations are not standard practice for all areas/institutions and it doesnt take that long to type out most things. It would be appreciated if the conditions were spelled out in the future. This especially annoys me on notes on our pediatric patients when the peds guys use some f'd up abbreviation for a condition I've not read about since med school.
On top of that, how would this information change our long term management of a guy who has a poor prognosis anyway?
As an anesthesiologist, would this be your reply if the primary team asked for your opinion on whether you can provide anesthesia for their patient?
Pt is pacemaker dependent. Would you bring the crash cart into close proximity of the MRI?
Cant put a swan in the MRI either.
This is completely elective procedure. Call cardiology/pacemaker company and see if they have any bright ideas since it is their piece of equipment.
Why not?
OK. what's your concern about the interaction between the pacemaker and the MRI
Once I was in the MRI scanner and who of all people forgot to take something metallic out of their pocket but the tech herself. We were in there for a while positioning the pt. when a caught the briefest glimpse of an object go whizzing through the air. So things really do become missiles but it wasn't quite as earth shattering as some people make it out to be.