Iatrogenic Hyperthermia During Cardiac Magnetic Resonance Imaging

Kussman, Barry D.; Mulkern, Robert V.; Holzman, Robert S.

doi:10.1213/01.ane.0000133911.79161.af

Cited by 23 publications

(5 citation statements)

References 9 publications

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“…Those studies showed that children (2-77 months) sedated for MRI studies with various drugs had increases, rather than decreases, in core temperature (17,19). Furthermore, hyperthermia, rather than hypothermia, has been reported in children receiving volatile anesthetics during anesthesia for MRI (18). One could postulate that our anesthetic technique or its length could have contributed to hypothermia in INCL patients.…”

Section: Discussionmentioning

confidence: 99%

Children with Infantile Neuronal Ceroid Lipofuscinosis Have an Increased Risk of Hypothermia and Bradycardia During Anesthesia

Miao

Levin

Baker³

et al. 2009

Anesthesia &Amp; Analgesia

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Background Neuronal ceroid lipofuscinoses (NCLs) are a group of autosomal recessive neurodegenerative diseases characterized by lysosomal accumulation of autofluorescent material in neurons and other cell types. The infantile subtype (INCL) is rare (1 in >100,000 births), the most devastating of childhood subtypes, and is caused by mutations in the gene CLN1 which encodes palmitoyl-protein thioesterase-1. Methods To investigate the incidence of hypothermia and bradycardia during general anesthesia in INCL patients, we conducted a case-control study to examine the perianesthetic course of INCL patients and of controls receiving anesthesia for diagnostic studies. Results Eight INCL children [mean age 25 months (range 10 to 32) at first anesthetic] and 25 controls (mean age 44, range 18 to 92 months) underwent 62 anesthetics for nonsurgical procedures. INCL patients had neurologic deficits including developmental delay, myoclonus, and visual impairment. INCL patients had lower baseline temperature (36.4±0.1 vs. 36.8±0.1, INCL vs. controls, p<0.007) and during anesthesia, despite active warming techniques, had significantly more hypothermia (18 vs. 0 episodes, p<0.001) and sinus bradycardia (10 vs. 1, p<0.001) compared to controls. INCL diagnosis was significantly associated with temperature decreases during anesthesia (p<0.001), whereas age, sex, and duration of anesthesia were not (p=NS). Conclusions We report that INCL patients have lower baseline body temperature and during general anesthesia, despite rewarming interventions, are at increased risk for hypothermia and bradycardia. This suggests a previously unknown INCL phenotype, impaired thermoregulation. Therefore, when anesthetizing these children, careful monitoring and routine use of warming interventions are warranted.

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Section: Discussionmentioning

confidence: 99%

Children with Infantile Neuronal Ceroid Lipofuscinosis Have an Increased Risk of Hypothermia and Bradycardia During Anesthesia

Miao

Levin

Baker³

et al. 2009

Anesthesia &Amp; Analgesia

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“…According to Isaacson, hypothermia (− 1 °C or more) is possible in young patients propofolsedated [22]. Conversely, a case of iatrogenic hyperthermia occurring in a 16-month-old infant during anaesthesia for cardiac MR (fentanyl, rocuronium, sevoflurane) was reported [23]. The patient was scanned with a head coil for 19 consecutive series over 95 min with a 1.5 T magnet.…”

Section: Biological Effects Of Non-ionizing Electromagnetic Fields Emmentioning

confidence: 99%

Is MRI imaging in pediatric age totally safe? A critical reprisal

et al. 2018

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Current radiological literature is strongly focussed on radiation imaging risks. Indeed, given there is a small but actual augment in cancer risk from exposure to ionizing radiation in children, it is important to understand what the risk of alternative techniques could be. We retrospectively review literature data concerning possible MR imaging risks, focussing on the biological effects of MR, sedation and gadolinium compound risks when dealing with infant patients. The main concerns can be summarized in: (1) Biological effects of non-ionizing electromagnetic fields (EMF) employed-whose mechanisms of interaction with human tissues are polarization, induced current, and thermal heating, respectively. (2) Risks associated with noises produced during MRI examinations. (3) Hazards from ferromagnetic external and/or implanted devices-whose risk of being unintentionally brought inside MR room is higher in children than in adults. (4) Risks associated with sedation or general anaesthesia, essential problem in performing MR in very young patients, due to the exam long-lasting. (5) Risks related to gadolinium-based contrast agents, especially considering the newly reported brain deposition.

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“…While most sequences in clinical use do not reach the SAR limit during a normal pediatric examination, there have been reports of temperature increases in infants during MRI. The worst reported case was that of a 16-month-old undergoing 90 min of cardiac MRI resulting in a temperature increase to 38°C, requiring oral antipyretics and overnight observation (55). Cardiac MR examinations can require long examination times with high RF power sequences, and the additional effects of anesthesia or sedation on thermoregulation in infants with congenital heart disease may mean that there is a particularly increased risk in this particular cohort of patients.…”

Section: Medical Exposure To Mri In Childhoodmentioning

confidence: 99%

Safety in pediatric imaging: an update

Arthurs

Bjørkum

2013

Acta Radiol

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Many assumptions are made when imaging children. In particular a judgement is made regarding how safe or unsafe each imaging modality is, using relatively arbitrary definitions and distinctions, due to the lack of robust scientific data. Here, the latest evidence is reviewed, particularly regarding the medical exposure to ionizing radiation (X-rays and CT) and MRI in childhood. The best evidence currently available suggests a small but convincing risk of cumulative low-dose ionizing radiation in children. Given our predictions for the children imaged today, it seems reasonable to pursue non-ionizing-based techniques wherever possible, although there is emerging evidence that MRI and ultrasound may have hitherto unknown effects. As our knowledge base expands, we must continually review our practice in light of the latest scientific data.

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Iatrogenic Hyperthermia During Cardiac Magnetic Resonance Imaging

Cited by 23 publications

References 9 publications

Children with Infantile Neuronal Ceroid Lipofuscinosis Have an Increased Risk of Hypothermia and Bradycardia During Anesthesia

Children with Infantile Neuronal Ceroid Lipofuscinosis Have an Increased Risk of Hypothermia and Bradycardia During Anesthesia

Is MRI imaging in pediatric age totally safe? A critical reprisal

Safety in pediatric imaging: an update

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