Anesthetic considerations for magnetic resonance imaging‐guided right‐heart catheterization in pediatric patients: A single institution experience

Abstract

Summary Cardiac catheterization is an integral part of medical management for pediatric patients with congenital heart disease. Owing to age and lack of cooperation in children who need this procedure, general anesthesia is typically required. These patients have increased anesthesia risk secondary to cardiac pathology. Furthermore, multiple catheterization procedures result in exposure to harmful ionizing radiation. Magnetic resonance imaging‐guided right‐heart catheterization offers decreased radiation exposure and diagnostic imaging benefits over traditional fluoroscopy but potentially increases anesthetic complexity and risk. We describe our early experience with anesthetic techniques and challenges for pediatric magnetic resonance imaging‐guided right‐heart catheterization.

Magnetic Resonance Imaging–Guided Cardiac Catheterization Evacuation Drills

“…6 Further details regarding equipment and room setup can be found in our previously published work. 1,2 The patient is moved via a transfer system consisting of an x-ray table and an MRI table (Combi Dockable Table, Siemens Healthineers) into the MRI scanner via the automatic door that separates the 2 suites. The automatic door is open only during times of patient transfer between the catheterization room and the MRI room.…”

“…This innovative procedure is now being performed successfully in adult and pediatric populations internationally. 1,2,5 Patients undergoing diagnostic cardiac catheterization, including MRI-guided procedures, are at risk for lifethreatening arrhythmias such as complete heart block and ventricular fibrillation. 6 These arrhythmias require immediate action, which can be challenging to implement in the interventional cardiac MRI (iCMR) environment.…”

Balancing competing risks

“…To date no analysis has specifically addressed the roles of radiation exposure dose (intensity times duration) or the duration of the surgical procedure as potential contributors to perioperative risk profile in children. The work by Deutsch et al in this issue of Pediatric Anesthesia further complicates the discussion of risk by forcing us to realize that as pediatric anesthesiologists we have done a poor job of analyzing competing risks . In this case, it is risk of radiation exposure as compared to the risk of prolonged anesthesia exposure in an ergonomically challenging environment.…”

“…The authors describe the successful implementation of cMRI‐guided right heart catheterization (MRI‐RHC) aiming to decrease radiation exposure while providing physiologic data comparable to that obtained by standard cardiac catheterization technology in children with CHD . The authors readily acknowledge that cMRI‐guided right heart catheterization is associated with increased duration of anesthesia exposure.…”

“…The work by Deutsch et al in this issue of Pediatric Anesthesia further complicates the discussion of risk by forcing us to realize that as pediatric anesthesiologists we have done a poor job of analyzing competing risks. 3 In this case, it is risk of radiation exposure as compared to the risk of prolonged anesthesia exposure in an ergonomically challenging environment.…”