The Impact of Intraoperative Magnetic Resonance Imaging on Patient Safety Management during Awake Craniotomy

Kotoe Kamata, Takashi Maruyama, Hiroshi Iseki, Minoru Nomura, Yoshihiro Muragaki, Makoto Ozaki

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Awake craniotomy paired with intraoperative magnetic resonance imaging (iMRI) is now the established technique for maximizing surgical resection, while preserving neurological function. However, leaving an unsecured airway patient in the iMRI gantry represents considerable risk. Our study aimed at identifying the incidence of critical adverse events in unsecured airway patients during iMRI as part of awake craniotomy. Materials and Methods: We conducted a clinical chart review of consecutive awake craniotomies performed between November 1999 and December 2015. Sequences of iMRI performed without invasive airway management were selected for assessment and the incidence of critical adverse events, including general convulsive seizure, respiratory arrest, nausea/vomiting and agitation, was identified. Results: Critical adverse events occurred in 21 of 356 unsecured airway patients within 24 of the 579 iMRI sequences. In cases using the low-field strength open MRI scanner, emergency termination of scans due to patient decline was recorded in only 4 cases: no cases of cardiac arrest, accidental death, or thermal injury were recorded. Compared with cardiovascular monitoring, patient respiratory status was poorly recorded. Conclusions: In terms of anesthesia, concurrent use of iMRI for awake craniotomy is clinically acceptable providing potential intraoperative complications can be controlled. Further, the configuration of the iMRI scanner as well as the reduced exposure from the lower magnetic field strength was found to impact patient safety management. Therefore when a conscious patient is left in the gantry without airway support, it is advisable that levels of oxygenation and ventilation should be monitored at all times.

Original languageEnglish
Pages (from-to)62-69
Number of pages8
JournalJournal of Neurosurgical Anesthesiology
Volume31
Issue number1
DOIs
Publication statusPublished - 2019 Jan 1
Externally publishedYes

Fingerprint

Safety Management
Craniotomy
Patient Safety
Magnetic Resonance Imaging
Airway Management
Incidence
Intraoperative Complications
Physiologic Monitoring
Magnetic Fields
Heart Arrest
Nausea
Vomiting
Ventilation
Seizures
Emergencies
Anesthesia
Hot Temperature
Wounds and Injuries

Keywords

  • awake craniotomy
  • intraoperative magnetic resonance imaging
  • patient safety

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

The Impact of Intraoperative Magnetic Resonance Imaging on Patient Safety Management during Awake Craniotomy. / Kamata, Kotoe; Maruyama, Takashi; Iseki, Hiroshi; Nomura, Minoru; Muragaki, Yoshihiro; Ozaki, Makoto.

In: Journal of Neurosurgical Anesthesiology, Vol. 31, No. 1, 01.01.2019, p. 62-69.

Research output: Contribution to journalArticle

Kamata, Kotoe ; Maruyama, Takashi ; Iseki, Hiroshi ; Nomura, Minoru ; Muragaki, Yoshihiro ; Ozaki, Makoto. / The Impact of Intraoperative Magnetic Resonance Imaging on Patient Safety Management during Awake Craniotomy. In: Journal of Neurosurgical Anesthesiology. 2019 ; Vol. 31, No. 1. pp. 62-69.
@article{5941471e8594441aac843b784fa54cb9,
title = "The Impact of Intraoperative Magnetic Resonance Imaging on Patient Safety Management during Awake Craniotomy",
abstract = "Background: Awake craniotomy paired with intraoperative magnetic resonance imaging (iMRI) is now the established technique for maximizing surgical resection, while preserving neurological function. However, leaving an unsecured airway patient in the iMRI gantry represents considerable risk. Our study aimed at identifying the incidence of critical adverse events in unsecured airway patients during iMRI as part of awake craniotomy. Materials and Methods: We conducted a clinical chart review of consecutive awake craniotomies performed between November 1999 and December 2015. Sequences of iMRI performed without invasive airway management were selected for assessment and the incidence of critical adverse events, including general convulsive seizure, respiratory arrest, nausea/vomiting and agitation, was identified. Results: Critical adverse events occurred in 21 of 356 unsecured airway patients within 24 of the 579 iMRI sequences. In cases using the low-field strength open MRI scanner, emergency termination of scans due to patient decline was recorded in only 4 cases: no cases of cardiac arrest, accidental death, or thermal injury were recorded. Compared with cardiovascular monitoring, patient respiratory status was poorly recorded. Conclusions: In terms of anesthesia, concurrent use of iMRI for awake craniotomy is clinically acceptable providing potential intraoperative complications can be controlled. Further, the configuration of the iMRI scanner as well as the reduced exposure from the lower magnetic field strength was found to impact patient safety management. Therefore when a conscious patient is left in the gantry without airway support, it is advisable that levels of oxygenation and ventilation should be monitored at all times.",
keywords = "awake craniotomy, intraoperative magnetic resonance imaging, patient safety",
author = "Kotoe Kamata and Takashi Maruyama and Hiroshi Iseki and Minoru Nomura and Yoshihiro Muragaki and Makoto Ozaki",
year = "2019",
month = "1",
day = "1",
doi = "10.1097/ANA.0000000000000466",
language = "English",
volume = "31",
pages = "62--69",
journal = "Journal of Neurosurgical Anesthesiology",
issn = "0898-4921",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - The Impact of Intraoperative Magnetic Resonance Imaging on Patient Safety Management during Awake Craniotomy

AU - Kamata, Kotoe

AU - Maruyama, Takashi

AU - Iseki, Hiroshi

AU - Nomura, Minoru

AU - Muragaki, Yoshihiro

AU - Ozaki, Makoto

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Awake craniotomy paired with intraoperative magnetic resonance imaging (iMRI) is now the established technique for maximizing surgical resection, while preserving neurological function. However, leaving an unsecured airway patient in the iMRI gantry represents considerable risk. Our study aimed at identifying the incidence of critical adverse events in unsecured airway patients during iMRI as part of awake craniotomy. Materials and Methods: We conducted a clinical chart review of consecutive awake craniotomies performed between November 1999 and December 2015. Sequences of iMRI performed without invasive airway management were selected for assessment and the incidence of critical adverse events, including general convulsive seizure, respiratory arrest, nausea/vomiting and agitation, was identified. Results: Critical adverse events occurred in 21 of 356 unsecured airway patients within 24 of the 579 iMRI sequences. In cases using the low-field strength open MRI scanner, emergency termination of scans due to patient decline was recorded in only 4 cases: no cases of cardiac arrest, accidental death, or thermal injury were recorded. Compared with cardiovascular monitoring, patient respiratory status was poorly recorded. Conclusions: In terms of anesthesia, concurrent use of iMRI for awake craniotomy is clinically acceptable providing potential intraoperative complications can be controlled. Further, the configuration of the iMRI scanner as well as the reduced exposure from the lower magnetic field strength was found to impact patient safety management. Therefore when a conscious patient is left in the gantry without airway support, it is advisable that levels of oxygenation and ventilation should be monitored at all times.

AB - Background: Awake craniotomy paired with intraoperative magnetic resonance imaging (iMRI) is now the established technique for maximizing surgical resection, while preserving neurological function. However, leaving an unsecured airway patient in the iMRI gantry represents considerable risk. Our study aimed at identifying the incidence of critical adverse events in unsecured airway patients during iMRI as part of awake craniotomy. Materials and Methods: We conducted a clinical chart review of consecutive awake craniotomies performed between November 1999 and December 2015. Sequences of iMRI performed without invasive airway management were selected for assessment and the incidence of critical adverse events, including general convulsive seizure, respiratory arrest, nausea/vomiting and agitation, was identified. Results: Critical adverse events occurred in 21 of 356 unsecured airway patients within 24 of the 579 iMRI sequences. In cases using the low-field strength open MRI scanner, emergency termination of scans due to patient decline was recorded in only 4 cases: no cases of cardiac arrest, accidental death, or thermal injury were recorded. Compared with cardiovascular monitoring, patient respiratory status was poorly recorded. Conclusions: In terms of anesthesia, concurrent use of iMRI for awake craniotomy is clinically acceptable providing potential intraoperative complications can be controlled. Further, the configuration of the iMRI scanner as well as the reduced exposure from the lower magnetic field strength was found to impact patient safety management. Therefore when a conscious patient is left in the gantry without airway support, it is advisable that levels of oxygenation and ventilation should be monitored at all times.

KW - awake craniotomy

KW - intraoperative magnetic resonance imaging

KW - patient safety

UR - http://www.scopus.com/inward/record.url?scp=85055084008&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055084008&partnerID=8YFLogxK

U2 - 10.1097/ANA.0000000000000466

DO - 10.1097/ANA.0000000000000466

M3 - Article

VL - 31

SP - 62

EP - 69

JO - Journal of Neurosurgical Anesthesiology

JF - Journal of Neurosurgical Anesthesiology

SN - 0898-4921

IS - 1

ER -