High frequency jet ventilator - a new approach in the management of anesthesia for pediatric cardiac Magnetic Resonance Imaging: case series

Background and objectives: 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. Case report: We report four cases of pediatric patients, ASA II, aged between 4 and 15 yearsold, 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 x 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 (R) , Acutronic Medical Systems). Good quality MRI images were obtained. At the end of the procedures, we observed increased salivation and increased end-tidal CO2 (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. Conclusions: 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. (C) 2019 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda.