ORIGINAL ARTICLE A prospective audit of safety issues associated with general anesthesia for pediatric cardiac magnetic resonance imaging Emma Stockton 1 , Marina Hughes 2 , Mike Broadhead 1 , Andrew Taylor 2 & Angus McEwan 1 1 Department of Anaesthesia, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, UK 2 Department of Cardiology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, UK Introduction Accurate and high-resolution imaging are vital to assist clinical decision making for the increasing population of pediatric patients with congenital heart disease (CHD) (1). Although transthoracic echocardiography will remain the first-line investigation in neonates and infants with CHD, poor acoustic windows often restrict the images of great vessels and extracardiac structures. With advances in technology and technique, cardiovascular magnetic resonance (CMR) has become an important imaging tool in the management of chil- dren with CHD (2,3). CMR itself is a fundamentally safe imaging tech- nique as it does not interfere with the electron shells involved in chemical bonding, in particular DNA (4). Keywords cardiac magnetic resonance imaging; congenital heart disease; anesthesia; pediatric; complications Correspondence Emma Stockton, Department of Anaesthesia, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK. Email: stocke@gosh.nhs.uk Section Editor: Greg Hammer Accepted 7 February 2012 doi:10.1111/j.1460-9592.2012.03833.x Summary Background/Objectives: Cardiac MRI (CMR) is increasingly used for surgi- cal planning and serial monitoring of children with congenital heart disease (CHD). For small children, general anesthesia (GA) is required. We describe our experience of the safety of GA for pediatric CMR, using data collected prospectively over 3 years. Methods: All consecutive infants undergoing GA for CMR at our institu- tion, between November 2005 and May 2008, were included. Informed and written consent to participate in research investigation was acquired from the guardians of every patient prior to CMR. The cardiac anesthetist com- pleted a standardized data collection form during each procedure. Informa- tion collected included demographics, diagnosis, surgical history, anesthetic management, significant incidents, and discharge circumstances. Results: A total of 120 patients with varying cardiac physiology and a range of hemodynamics underwent GA for CMR during the study period. Gas induction was predominantly used, even in those with impaired ven- tricular function. The majority (71%) of procedures were undertaken with- out significant incident. Minor adverse incidents were recorded in 32 patients, mild hypotension being most frequent. One major adverse event occurred. A patient with hypoplastic left heart syndrome (HLHS) suffered hypotension then cardiac arrest in the scanner. This patient was success- fully resuscitated. Conclusion: Although the majority of cases were safe and without incident, the complication rate in children with CHD receiving a GA for CMR is higher than in the general pediatric population. This reinforces the need for a senior, multidisciplinary team to be involved in the care of these chil- dren during imaging. Pediatric Anesthesia ISSN 1155-5645 ª 2012 Blackwell Publishing Ltd 1