Magnetic resonance imaging (MRI) is among the safest imaging technologies available, since it doesn’t involve the usage of ionizing radiation like X-ray or CT scans do. The demand for this technology is growing 7.1% a year, largely due to the fact that healthcare providers are under growing pressure to avoid hazardous imaging techniques.
However, it is common for patients undergoing an MRI to experience anxiety and discomfort because of the claustrophobic effect caused by the machine. This is usually more of an issue for them than the cost of an MRI. Sometimes this anxiety can be decreased by offering your patient ear plugs or by inviting them to bring their own headphones and music.
When this isn’t enough to decrease your patient’s anxiety, sedation will help them get through the procedure without concern. Procedural sedation for MRI is commonly used to alleviate discomfort, especially for children or anxious patients.
In this post, we’ll discuss the different variations of MRI sedation that can be used, what to expect during the procedure, and the necessary information to know before an MRI screening.
Minimal Sedation for MRI Patients: When to Use
Minimal MRI sedation, as the name implies, is the safest and lightest level of sedation. It uses nitrous oxide (laughing gas) or oral pills. Doctors use minimal sedation for MRI procedures to make the patient feel more relaxed and calm while retaining responsiveness and consciousness. This level of MRI sedation is considered safe and commonly used on patients who feel anxious or uncomfortable.
Minimal Sedation: Risks and Side Effects
In radiology, minimal sedation is administered through benzodiazepines or nitrous oxide inhalation. However, doctors need to avoid giving these sedatives to patients that don’t really need them, since there is a high risk of addiction. At the very least, doctors need to warn their patients about the risk of addiction to benzodiazepines.
Other than the risk of addiction, there are few problems with giving these medications to patients for a one time MRI. Both types of minimal sedation typically have very few contraindications or side effects. However, a doctor needs to determine if it is safe for the patient to undergo sedation, as this can vary from person to person.
Benzodiazepines: Dangers and Clinical Considerations
Benzodiazepines are a common solution to anxiety and a viable treatment option for patients experiencing moderate anxiety before an MRI. Medications like Ativan, Xanax, or Valium can help patients relax and be more comfortable during the procedure.
A doctor should decide when it is suitable for the patient to be taking benzodiazepines and patients should avoid driving after taking them or any other sedatives that may be given to them throughout the procedure.
Using benzodiazepines might not be a good idea in some circumstances. For instance, benzodiazepines should not be taken by pregnant or nursing women since they can cause unintended side effects for the unborn child or the mother.
In addition, taking benzodiazepines along with other drugs or alcohol may increase the sedative’s potency and increase the risk of respiratory problems, suicidal thoughts, or actual suicidal behavior. When used with benzodiazepines, recreational drugs have also been known to result in hazardous issues.
Benzodiazepines should be avoided by people with lung conditions or breathing issues, sleep apnea, severe liver or renal disease, or severe myasthenia gravis, or they should be prescribed at a lower dose. A personality disorder diagnosis and a history of substance misuse are further reasons not to take benzodiazepines. It is important to note that benzodiazepines are not recommended or suited for children, and older people should generally be given a lower dose.
Nitrous Oxide: Negative Effects
Nitrous oxide is sometimes referred to as “laughing gas” or “happy gas.” It is a fairly recent sedation alternative used to assist patients in managing their discomfort and anxiety during procedures. Nitrous oxide has the benefit of working immediately after being breathed in through a mask, and nitrous oxide’s effects end as soon as the mask is taken off, allowing patients to resume their regular activities right away.
However, nitrous gas has several unfavorable side effects, despite being regarded as a secure sedation method. Common side effects include temporary dissociation, dizziness disorientation, loss of balance, poor memory and cognition, and weakness in the legs. Fortunately, once the patient has stopped inhaling nitrous oxide these effects will often go away quickly.
Before administering nitrous gas, a doctor will examine the patient’s medical history and any allergies the patient may have to make sure sedation is a safe option for them. The choice to utilize nitrous oxide for a child will be based on both the sort of radiologic procedure being done and the child’s medical records. Usually, most patients find nitrous oxide to be a secure procedure in sedation for MRI.
Moderate or “Conscious” Sedation During MRI
Moderate sedation is a higher level of MRI sedation used in radiology for more severe cases of claustrophobia. Moderate or conscious sedation involves using intravenous sedatives to help the patient relax during the MRI.
With a higher level of sedation being administered, a patient is still conscious and awake during the entire procedure. However, because of the higher level of sedation, a patient may not remember some or all of the procedure and is likely to slur their words for a short time after the procedure.
It’s important to note that the procedure is safe to perform and poses little risk to the patient, but it needs to be performed by trained specialists with experience in sedation.
During the procedure, the patient’s vital signs must be closely monitored, and the level of sedation will be adjusted as needed to ensure patient safety and comfort. A doctor will also provide patients with instructions on how to prepare for the procedure and any necessary precautions to take afterward.
If you’re looking to brush up on your knowledge regarding sedation for MRI procedures and how to administer sedatives carefully, you should consider enrolling in moderate sedation training. The curriculum was created by experienced doctors, physicians, and dentists who are sedation experts, and the course itself is entirely virtual.
Moderate Sedation: Risks and Side Effects
For moderate sedation in radiology, the combination of fentanyl and midazolam is commonly used. It’s essential to take necessary precautions to ensure patient safety while using these drugs.
Patients should inform their doctors about other medications they take before the sedation and should be closely monitored by their doctors before, during, and after the procedure. Additionally, there are risks and side effects associated with moderate MRI sedation that patients should know of to prevent any problems that may arise.
Who Should Not Get a Midazolam Injection
Midazolam is a commonly used medication for moderate sedation during medical procedures, including sedation for MRI.
However, individuals with certain medical conditions should avoid it. These conditions include:
- Drug abuse
- Closed-angle glaucoma
- Chronic heart failure
- Constriction of blood vessels in the extremities
- Decreased lung function
- Hardening of the liver
- Acute kidney failure
- Chronic obstructive pulmonary disease
- Instability of the heart or circulation.
For pregnant women, the safety of using midazolam has not yet been established. According to the FDA, studies have shown evidence of harm to the fetus and there have been reports of adverse effects on newborns when the mother received doses of midazolam in the later stages of her pregnancy. Therefore, the use of midazolam in pregnant women should be carefully considered, and alternative options should be explored if possible.
Fentanyl: Drug Facts
Fentanyl is a potent opioid medication used for pain management. A patient must inform their doctor of any other medications they are taking, especially those that induce sleepiness or inhibit breathing, as they may have severe consequences when taken after the administration of fentanyl.
The usage of fentanyl is contraindicated in patients with liver failure or respiratory problems, such as if the patient is asthmatic or has sleep apnea. If a patient has a known intolerance to fentanyl or other morphine-like drugs or is allergic to any medicinal component within fentanyl, it should not be used.
Fentanyl should not be used with other specific drugs, such as certain antifungal medicines or certain antibiotics, as they may increase the drug’s effects and lead to respiratory depression. Fentanyl is also not recommended if the patient has used a monoamine oxidase inhibitor within the previous fortnight.
Ultimately, MRI sedation has enabled patients with claustrophobia and pediatric patients to undergo these procedures.
When giving sedation to children under three years old, extreme care must be used. But generally, sedation for MRI has the potential to enhance patient care overall by facilitating safer treatments, more efficient workflows, and lower costs.