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• W4313268512 abstract "Dear Editor, Anesthesia management for magnetic resonance imaging (MRI) of conjoined twins poses challenges to deal with two infants simultaneously, unfamiliar environment, limited space and personnel.[1] Providing anesthesia for MRI to conjoined twins is a rare opportunity that requires two MRI compatible anesthesia workstations. We report a peculiar problem due to different terminal wall-mount outlets in MRI complex. Six-month-old pyopagus conjoined twins were scheduled for MRI. We have three MRI suites in one complex and all are equipped with MRI compatible anesthesia workstations. Two separate anesthesia teams, two sets of MRI compatible workstations, monitors, equipment, drugs, infusion pumps and suction were arranged. We planned to shift a second workstation from one of the other suites. MRI compatible full oxygen (O2) cylinders were ensured for both workstations. MRI suite-I had two pipeline sources of O2, and one each for nitrous oxide, air and suction units. We planned O2, nitrous oxide, isoflurane for maintenance of anesthesia for twin-1 and O2, air, isoflurane for twin-2. We noticed that the anesthesia workstation of MRI suite-II did not have compatible gas pipeline connection to be fitted in suite-I. There was no separate compatible tubing to connect the workstation to wall gas outlets. We had two options; first, to use 100% O2 from cylinder without any air or nitrous oxide due to unavailability of MRI compatible nitrous oxide and air cylinder. Second, to use workstation from suite-III. We decided to use the workstation from the suite-III which had compatible tubing. Case was done uneventfully. We observed presence of different terminal wallmounts in two adjacent MRI suites. MRI suites, I and III had quick connect probes with Geometric Index Safety System and MRI suite-II had quick connect probes with indexing collars for oxygen, nitrous oxide and air [Figure 1a and b].[2,3] Recovery room had probes with pin index safety system in the terminal wall-mount outlet [Figure 1c]. We noticed that MRI suites were built by different companies and all the equipment needed in the suite including anesthesia machine, monitor, wall mount assembly for gases etc., were provided by that particular company. Breakdown of anesthesia workstation requiring repair or replacement is not uncommon. Anesthesia for conjoined twins requires utilization of 2 anesthesia workstations in a single room. All workstations in a hospital complex should have same terminal wall mount assemblies and same hose pipe connectors for ease of exchange of workstation in any given scenario. We did not find any guidelines regarding types of wall mount assembly and pipeline connectors in one unit/complex. This may have led to installation of wall-mounts in non-uniform way.Figure 1: Different types of terminal wall mount gas outlets at MRI complex. (1a). Quick connect with geometric index safety system. (1b). Quick connect with indexing collars safety system. (1c). Quick connect with pin index safety systemWe suggest that there should be a central committee in every hospital which must include at least one anesthesiologist along with other technical experts who can contribute in planning and designing of all areas requiring anesthesia services including operation theatre complex, recovery room, radio-diagnostics, radio-therapeutics, Cath-lab, Intensive Care unit, emergency room and similar areas. This team should make sure that there is uniformity in terminal wall mount all across the hospital to avoid such issues. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest." @default.
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• W4313268512 date "2022-01-01" @default.
• W4313268512 modified "2023-10-18" @default.
• W4313268512 title "Uncommon concern during MRI of conjoined twins under general anesthesia" @default.
• W4313268512 cites W2506250655 @default.
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• W4313268512 doi "https://doi.org/10.4103/joacp.joacp_553_20" @default.
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