Expert: Ronald Levy, M.D. - 4/6/2010

Question
I need to have an MRI done to diagnose a problem with pain in my foot; other tests have been negative.   I'm 52 and other than my foot problem, I'm healthy, don't take any meds and was told that I'm an excellent risk for anesthesia.  They are using a MRI machine that encloses me from the shoulders down and they have told me  that this is the most "open" type of machine that they can use and still get the quality images that we need; the test will last 45 minutes.  Despite the best efforts of a great MRI nurse, I had severe panic attacks during the first test and could not complete the test. The doc who ordered the test basically refused to give me any meds because he said: "it's all in your head and I don't believe in giving drugs for so-called MRI claustrophobia".  I really wanted to get the test,,so I went to a doc in the box and got a RX for Xanax, which I took as instructed before  the second attempt, which was exactly like the first.  I have never been so frustrated in my life; I'm a physicist and understand the technology; I just can't do this test.  Awful doesn't even begin to describe the panic that I felt.  The MRI doc had me see an anesthesia provider adn she told me that I could have the test done under general anesthesia. I asked if she meant general or just sedation she would use general; that the failure rate with conscious sedation was too high. She reviewed my records and said that my reaction was way beyond sedation.  Even thinking about a repeat exam makes me sweat and my heart race.  I'm just nervous about getting general for a test that's normally done with nothing. Is this o.k.?   It was frustrating that the surgeon "doesn't believe in MRI claustrophibia".  She rescheduled the MRI for one week and gave me a RX for a week's worth of Xanax for any panic attacks that I might have (which was really nice since I didn't ask for a RX). And she will provide a general anesthetic (propofol, sevo etc) and a LMA for my airway.  The anesthesiologist spoke with the doc in a box and that's what they are suggeting.  The surgeon a a great surgeon, but he doesn;t think that anything is required for an MRI.  When I called him on the phone, he was not happy and said "do you think that you are getting controlled drugs for a simple MRI?"  As if I want anything, just a completed test.  The anesthesia doc is super; I wish that she was the surgeon (I would find a new one, but he's pretty good).  Is it really o.k. to get general for severe mri claustrophobia?   I'm so embarassed by this and the surgeon is calling me a wimp by "drug-seeking".  I didn't think that asking for one dose was a problem.  I trust the anesthesia doc; is general o.k./ thanks

Answer
First of all, what the surgeon thinks is completely irrelevant. All he wants to see is the MRI results. He doesn't care how he gets them. Don't worry about him. Frankly you don't even have to tell him how you got your test. Let him think you just did it. As for the more important problem, you, be assured that MANY people have MRI claustrophobia. While I personally don't, I have had several MRIs myself and I can see how it could affect some people. We often do general anesthesia for MRIs (when sedation is unlikely to suceed). Since you are otherwise healthy, I don't see any problem with giving you a general. Relax and be assured that your next MRI will be far more pleasant.


Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston