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Safety of MRI Examinations Under Sedation: A Nationwide Survey in Japan
Shiori Amemiya1, Masako Kataoka2, Tsukasa Doi3
1Department of Radiology, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
Background:
MRI is performed under sedation for patients requiring immobility or for those already sedated for clinical management. Although specialist guidelines advocate for anesthesiologist-led care, non-anesthesiologist-led adult sedation is a common practice worldwide. Furthermore, the increase in risk attributable to sedation has not been quantified.
Purpose:
To investigate MRI sedation practices in Japan to quantify associated risks and to identify key safety vulnerabilities.
Study Type:
Survey.
Subjects:
Data were collected from 549 Japanese medical institutions.
Assessment:
A web-based questionnaire was distributed to members of major Japanese radiological societies to assess institutional policies, sedation management practices, safety measures, and historical adverse events. The survey primarily concerned deep sedation and general anesthesia in adults but also encompassed questions on minimal-to-moderate sedation and pediatric sedation.
Statistical Tests:
Chi-squared test, Welch's t-test, Fisher's exact test were used. Odds ratios (ORs) were calculated based on the cumulative number of adverse events over 2 years to examine the increased risk from sedation. p < 0.05 was considered significant.
Results:
Adult MRI sedation management is typically led by attending physicians (84%) with limited consultation from anesthesiologists for sedation (9.0%) or radiologists for scan indication (5.1%). Safety infrastructure was often inadequate, with MRI-compatible ventilators (48%) or syringe pumps (29%) and capnometers (24%). In an analysis combining both pediatric and adult data, the ORs for the total sedated group versus non-sedated group were 62 (95% confidence interval, 54-73) for peripheral capillary oxygen saturation drop, 48 (32-72) for respiratory arrest, 15 (8.0-28) for cardiac arrest, 6.7 (2.0-23) for physical trauma, and 8.9 (4.0-20) for projectile accidents.
Data Conclusion:
MRI examinations under sedation are associated with a substantially higher risk of adverse events. Developing and implementing a standardized protocol may mitigate these procedural risks.
Stage Of Technical Efficacy:
5.
Insights
Sedation for MRI scans significantly increases the risk of adverse events, including respiratory and cardiac arrest. Implementing standardized protocols is crucial for mitigating these procedural risks in MRI sedation.
Area of Science:
- Medical Imaging
- Anesthesiology
- Patient Safety
Background:
- Magnetic Resonance Imaging (MRI) often requires sedation for patient immobility or clinical management.
- While guidelines recommend anesthesiologist-led care, non-anesthesiologist-led sedation is prevalent.
- The quantified risks associated with MRI sedation have been lacking.
Purpose of the Study:
- To investigate MRI sedation practices in Japan.
- To quantify the risks associated with MRI sedation.
- To identify key safety vulnerabilities in MRI sedation procedures.
Main Methods:
- A web-based survey was distributed to 549 Japanese medical institutions.
- The survey assessed institutional policies, sedation management, safety measures, and adverse events.
- Statistical analyses included chi-squared, Welch's t-test, and Fisher's exact tests to calculate odds ratios (ORs) for adverse events.
Main Results:
- Adult MRI sedation is predominantly led by attending physicians, with limited anesthesiologist involvement.
- Inadequate safety infrastructure was noted, including low availability of MRI-compatible ventilators and capnometers.
- Sedation significantly increased the risk of adverse events, with ORs for oxygen saturation drop (62), respiratory arrest (48), and cardiac arrest (15).
Conclusions:
- MRI under sedation is linked to a substantially elevated risk of adverse events.
- Developing and implementing standardized protocols can help mitigate procedural risks.
- Addressing safety vulnerabilities is essential for improving patient outcomes during MRI sedation.
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