I was reminded of this conundrum during HOUSE M.D. this week when a small child had to be urged by his parents to lay perfectly still during an MRI. I’ve had many an MRI in my day and I’m here to tell you, it’s hard to lay still. I’ve had one or two started over because of a leg twitch or the tiniest movement I thought they wouldn’t detect.
So why wouldn’t you sedate a patient with either something like valium taken two hours before…or a twilight sleep, not full anesthesia, but knock the person out to keep them from moving?
I was given a small dose of valium the first time I had an MRI (1989). The machines were more enclosed than they are now, and I am extremely claustrophobic. They offered it to me without me asking.
You still move even when sedated. I am told that on two occasions when I was sedated, I tried to roll over on my side because that’s the way I usually sleep. If I’m conscious, I could at least make an effort to control myself.
Whut he said. Better to plan first to have the patient informed to relax and hold still. This works for over 90% of patients (WAG based on having reports on thousands of patients of mine who had MRIs). If problems arise, then drugging and restraining someone can be considered.
having had an MRI back in '88 I have to agree with this. I tend to twitch my legs as I fall alseep. And anyway I didn’t have to lay perfectly still the whole time. They would tell me, when to keep perfectly still as opposed to just still.
Still if you aren’t afraid of enclosed spaces by the time you’re finished with an MRI you just might be.
I was quite comfortable in the “tunnel” type machine, I think I even dozed off a couple of times. There was never any complaint of my moving. Also I’m a big guy, 6’1", 260, so it was a fairly tight fit.
One of the many jobs I’ve had over the years was giving sedation to pediatric patients for MRI, then monitoring them in the room while they were scanned.
There were a few adults that required sedation as well. There’s no reason not to give it. It just isn’t necessary in most adults. House has about as much relation to real medicine as the game Operation
I recently discovered that I was claustrophobic getting an MRI. Halfway in I sort of panicked and oozed out of the machine and onto the floor. I came back the next week with a diazepam smile and a designated driver.
Forget MRIs; who’s the sadistic bastard whos thinks it’s OK to not sedate someone who’s getting a vasectomy? :eek: Sure, you don’t feel anything due to the local anesthetic, but why do you have to be cognizant of it at all? ::shudder::
An Arky, who’s getting a vasectomy in the near future.
Along with all the other ridiculous things we see on House, I could not help but wonder when the youngster was put in the MRI machine.
I had one of my brain a few years back (yeah, it was still in there), and they blocked my head with plastic dohickys and strapped it down so could not have moved it if I had wanted to. Seems to me that’d especially do that with a young restless kid, but, ah well, it **is **fiction, isn’t it?
Today, they can use what are called open MRI’s, that are sort of C-shaped, for those of us who are too claustrophobic to be put into those little cigar tubes. But when I had to go into the older one for a neck scan, I tried my best to do it, but I just couldn’t. My doc prescribed Atavan. I picked up the Rx and found two tabs in the container. There were no directions and when I called his office I couldn’t get through, so I took one on the way there (wife driving). Didn’t feel much, so before going in, I took the other one. I did fine, I hear. I didn’t move. I didn’t even mind the machine, although it was not totally enclosed, either. But I was certainly sedated. In fact, when I went back the next day to pick up the films, I couldn’t find the lab. Didn’t remember my way around the building. Yep- they sedate you, ok.
The unfortunate thing about the open magnets is that they generate a magnetic field which is much weaker (0.2-0.3 Tesla on the typical open machine vs. 1.5 Tesla on the standard modern full tube scanner) and less homogeneous (which matters for technical reasons too hairy to explain here). As a result, the images you get are far less valuable diagnostically - sometimes nearly useless.
Thus, the open magnet is sort of a tool of last resort for the really claustrophobic patients. We do use the head restraints someone mentioned if the patient can deal with it. Of course, with small children telling them to hold still can only work to a point, and we do end up doing a lot of scans with anesthesia involved. If a kid is sedated, they can then be put in various holding devices (as an aside… there is a device used to hold an infant still for an x-ray called a “piggostat”… I’m not kidding) and will then hold still quite well, though this is a major pain in the butt because of all the monitoring gear you have to somehow make fit into the bore of the magnet with them.
You know, there’s all this talk of claustrophobia with relation to MRI machines, but it seems to me only a tiny percentage of people are claustrophobic – right?
