Anesthesia can be safely provided for children in a high‐field intraoperative magnetic resonance imaging environment

Summary Objectives:  To describe the challenges associated with providing safe anesthesia and perioperative care for children in a remote intraoperative magnetic resonance (iMR) operating room (OR) and to identify perioperative anesthesia outcomes, including adverse events related to the iMR environment. Background:  Increasingly, children undergo neurosurgical procedures in a high‐field iMR OR. We describe a 10‐year experience of providing anesthesia for children in this environment with a mobile 1.5‐Tesla magnet. Methods:  A 10‐year retrospective analysis was conducted of children who underwent neurosurgical procedures in a high‐field mobile iMR OR. Primary outcomes related to perioperative adverse events and recovery profiles. Results were expressed as mean ±  sd or median (range), as appropriate. Results:  One hundred and five procedures were performed on 98 children, aged 4 months–18 years, weighing 6–112 kg. The commonest two diagnostic categories were tumor ( n  = 52) and seizures ( n  = 27). Median anesthetic time was 439 (185–710) mins. There were no significant adverse events related to the iMR environment. The mean postanesthetic care unit admission temperature was 37 ± 0.9°C and the mean modified Aldrete Score at 30 mins was 7.2 ± 0.9. Two patients experienced seizures in the immediate postoperative period, readily controlled with propofol. There was one breach of MR safety protocol, and no adverse events related to patient transport. Conclusions:  Anesthesia and perioperative care of children in an iMR setting were associated with a very low incidence of complications, despite the duration of the procedures involved. Such success depends upon a cohesive team‐based approach.