Anaesthesia · Day-Care, Remote-Location Anaesthesia and Procedural Sedation (MAC)

In remote-location anaesthesia (e.g., MRI suite, cardiac catheterisation lab), which unique challenge distinguishes it from theatre-based anaesthesia?

  • A Greater availability of trained assistants and backup equipment
  • B Requirement for longer acting drugs because procedures are always longer
  • C Distance from the main operating theatre, MRI-incompatible equipment, limited anaesthetic gas scavenging, and restricted patient access
  • D Mandatory use of ketamine because volatiles are not available remotely
Correct answer: C. Distance from the main operating theatre, MRI-incompatible equipment, limited anaesthetic gas scavenging, and restricted patient access

Explanation

Remote-location anaesthesia carries unique challenges: (1) physical distance from anaesthesia support, backup drugs, difficult airway equipment, and emergency teams; (2) MRI incompatibility of standard anaesthesia machines, monitoring cables, and metallic airway tools — requiring MRI-conditional equipment; (3) limited or absent anaesthetic gas scavenging in catheterisation labs, mandating TIVA; (4) restricted access to the patient during scanning; and (5) unfamiliar environment with poor lighting and cramped space. These hazards require meticulous pre-procedure checklist completion and a fully stocked resuscitation trolley.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

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