The anesthesia for investigations
The anesthesia department within Neuromed Clinic provides the sedation of the claustrophobic patients, pediatric patients, the analgesia of the patients who cannot undergo imaging investigations due to the pain, as well as the supervision of the critic patients.
Our experience in the field of the sedation for the MRI or computed tomography is large, by exceeding a total of 15,000 anesthetics and started 20 years ago once with the imaging discoveries within Neuromed Diagnostic Imaging Center and still continues. A large number of sedations are performed within Neuromed Clinic to critic patients, pediatric patients (4-5 per day), newborns, of which we performed over 300 investigations to children with heart defect, which is a very difficult pathology to manage in the anesthesia field. Our patients’ age is between 6 hours and over 90 years.
Who needs the anesthesia?
Claustrophobic patients - The claustrophobia or the fear of enclosed spaces is an anxiety disorder that often gives rise to panic attacks. Globally speaking, about 5-7% of the population is affected by the severe claustrophobia.
Claustrophobic patients – The claustrophobia or the fear of enclosed spaces is an anxiety disorder that often gives rise to panic attacks. Globally speaking, about 5-7% of the population is affected by the severe claustrophobia. The claustrophobic patients cannot stand still during the investigations that last between 5 minutes (in case of the computed tomography) and 2 hours (in case of the magnetic resonance) and need to be sedated in order to maintain their position during the examination.
- Pediatric patients - who cannot understand the necessity of the investigations due to their age or children with the hyperkinetic syndrome, those with attention deficit that cannot stand still even if they want to, as well as those retarded, are sedated because the investigations are needed and cannot be performed otherwise.
- Patients requiring analgesia for chronic diseases or malignancies also benefit from the presence of the anesthetist who can administer various medicines, such as anti-inflammatory substances and opioid analgesics in order to remove pain.
- Comatose patients, patients with prostheses and with respiratory deficiencies, are monitored, ventilated and sedated in order for the hemodynamic and respiratory parameters to be maintained throughout the examination.
The preparation prior to the anesthesia
- In order to perform the anesthesia it is necessary to have a fasting period, which is globally the same for all cases requiring anesthesia, namely 6 hours for solids and 2 hours for liquids. Therefore, 4 hours after not eating solid food, the patient cannot drink water or tea (clear liquids) anymore, then 2 hours before the investigation it is prohibited to eat or to drink anything.
- The patients with respiratory virus cannot undergo anesthesia due to the risk of bronchospasm, acidosis, and respiratory arrest. Once the problem is resolved (no fever, cough, runny nose), the procedure can be performed safely 5 days later.
If the investigation is urgent and the patient’s life depends on this examination, the risk of the procedure shall be explained, the maximum safety measures shall be taken and the anesthesia investigations shall be performed as soon as possible.
The patients need to know that after the anesthesia they will feel sleepy for about 3 hours and they will not be allowed to drive the car the respective day.
The parameters monitored during the anesthesia
The anesthesia is performed with oxygen mask or eyeglasses in order to increase the fraction of the inspired oxygen, the blood pressure, the peripheral oxygen saturation and heart rate are monitored, and in case of coronary patients and children with heart defects the investigation is performed by continuous ECG.
The anesthetist, the emergency department physician and the operator performing the investigation can see the patient through the MRI or computed tomography scanner window, on the monitor recording the patient’s face for any grimacing, involuntary face movements and continuously monitor the parameters mentioned above.
Each device (one computed tomography scanner and two MRI scanners) is equipped with complete intubation kits, defibrillators, suction device for oropharyngeal secretions, oxygen sources within the rooms intended for the patients’ preparation and examination.
Like any medical act, the anesthesia involves several risks, such as apnea, heart rate and rhythm disorders, blood pressure changes,
allergic reactions to anesthetics substances or contrast agent, pain or hematoma located to the place of the intravenous puncture and rarely cardio-respiratory arrest.
The potential complications are influenced by a series of elements such as: age, related pathology, interaction of some anesthetic substances with the chronic treatments administered to patients, the use of toxic substances (alcohol, cigarettes, drugs), as well as by the particular anatomical features: malformations or deformities of the face, chest or spine, obesity or other changes in the body that prevent normal breathing.
Special recommendation for the patients with chronic diseases
- The hypertensive patients who take antihypertensive medication shall not stop taking these medication, especially the beta-blockers (Atenolol, Carvedilol, Nebilet, Concor and Metaprolol), which can be taken 2 hours before the anesthesia, when they are still allowed to drink clear liquids.
- The patients with antiepileptic treatment shall not interrupt the medication. However, if they forget to administer the medication before the investigation, they need to know that during the sedation or anesthesia investigation are protected against the seizures by the anticonvulsant action of the benzodiazepines used during the anesthesia.
- The patients with type I hyperglycemia are not allowed to eat or to administer the insulin and those with type II hyperglycemia who take oral anti-diabetic medication are not allowed to eat, to take their pills, provided that in what concerns the hypoglycemia, we can find out the value of the blood sugar in less than 1 minute and we can take the appropriate measure, if the case may be.
- The patients with acknowledged hyperthyroidism who are about to undergo a contrast agent computed tomography should have a thyroid hormone dosage or at least of the TSH value in order to avoid a thyrotoxic crisis.
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