The anaesthetist's role in the setting up of an intraoperative MR imaging facility

The clinical and economic advantages of intraoperative magnetic resonance (MR) imaging for neurosurgery are apparent. Hence, more medical institutions are setting up such services. Establishing such a service can be daunting because of the cost and specifications, its highly technical nature and many safety considerations. The anaesthetists have an integral part to play during this process because of their stake as key users and their vital role in conducting anaesthesia for complex neurosurgery within this hostile, and sometimes remote, environment. Moreover, their experiences with efficient workflows, patient screening and concern about safety make them eminently qualified members of the planning and building process. They are also no strangers to budgets and equipment appraisals. The complex interactions between conducting anaesthesia in a hostile environment and in a remote site conspire to make this a challenging undertaking. This article describes the role, the practical considerations and the difficulties experienced by the neurosurgical anaesthetists in setting up an intraoperative MR imaging operating theatre at Singapore General Hospital, from planning to equipment procurement and streamlining the workflow. Safety concerns and training are vital aspects of this article. It is hoped that our experiences will be of help to others who will be called upon at some point in a similar undertaking.