Rodrigues João Tiago, Oliveira Carmen, Ferreira Ana Pinto
Centro Hospitalar de Vila Nova de Gaia, Espinho, Portugal.
Centro Hospitalar de Vila Nova de Gaia, Espinho, Portugal.
Braz J Anesthesiol. 2019 Nov-Dec;69(6):626-630. doi: 10.1016/j.bjan.2019.08.007. Epub 2019 Nov 30.
Cardiac Magnetic Resonance Imaging (MRI) is a technique used for evaluation of children with congenital heart diseases. General anesthesia ensures immobility, particularly in uncooperative patients. However, chest wall movements can limit good quality scans. Prolonged apnea may be necessary to decrease respiratory motion artefacts, potentially leading to hypoxemia and other adverse events. The use of a high frequency jet ventilator may be a solution avoiding chest wall movements.
We report four cases of pediatric patients, ASA II, aged between 4 and 15 years-old, scheduled for cardiac MRI. General anesthesia was proposed and parental informed consent was obtained. After general anesthesia was induced, an uncuffed endotracheal tube was inserted. Then, a 7Fr × 40 cm catheter was placed through the endotracheal tube. The proximal outlet of the catheter was attached through a connecting tube to a high frequency jet ventilator (Monsoon III®, Acutronic Medical Systems). Good quality MRI images were obtained. At the end of the procedures, we observed increased salivation and increased end-tidal CO (60–70 mmHg), in all patients. The patients were extubated after normocapnia was achieved and neuromuscular blockade reversed. Following appropriate recovery time, the four children were discharged home the same day.
This case series demonstrates that the use of a high frequency jet ventilator for cardiac MRI was feasible, safe, providing good quality cardiac imaging and avoiding anesthesia personnel to be inside the hazardous environment of MRI room. Future studies are needed to confirm its safety and efficiency in pediatric patients.
心脏磁共振成像（MRI）是一种用于评估先天性心脏病患儿的技术。全身麻醉可确保患儿保持静止，尤其是对于不合作的患儿。然而，胸壁运动可能会限制高质量扫描。可能需要延长呼吸暂停时间以减少呼吸运动伪影，但这可能会导致低氧血症和其他不良事件。使用高频喷射呼吸机可能是一种避免胸壁运动的解决方案。
我们报告了4例年龄在4至15岁之间、ASA II级的儿科患者，计划进行心脏MRI检查。我们提出了全身麻醉并获得了家长的知情同意。诱导全身麻醉后，插入一根无套囊气管内导管。然后，通过气管内导管放置一根7Fr×40cm的导管。导管的近端出口通过连接管连接到一台高频喷射呼吸机（季风III型®，阿库特隆医疗系统公司）。获得了高质量的MRI图像。在检查结束时，我们观察到所有患者的唾液分泌增加，呼气末二氧化碳分压升高（60 - 70mmHg）。在恢复正常二氧化碳分压并逆转神经肌肉阻滞作用后，对患者进行了拔管。经过适当的恢复时间后，这4名儿童于同日出院回家。
该病例系列表明，在心脏MRI检查中使用高频喷射呼吸机是可行且安全的，能够提供高质量的心脏成像，同时避免麻醉人员进入MRI室的危险环境。未来需要开展研究以证实其在儿科患者中的安全性和有效性。
