Patient should not feel alone. During the procedure, constant contact with the patient is necessary. According to the equipment’s instructions for the procedure’s safety, the patient is required to give an emergency stop button in his hand. But this is not enough. The patient must know when to press the button and what sensations are normal and should not cause alarm. Instruction is crucial.
Normal sensations in patients during MRgFUS sonication:
- Mild pain
Sensations that require MRgFUS sonication to stop
- Extreme pain
- Neurological deficits
The patient should feel safe and awake and communicate with the surgical team throughout the procedure. If the patient feels safe, he avoids interruption of sonications. He achieves a better result in terms of efficiency and a smaller edema size in the treated area in terms of safety.
To create favorable conditions for the effective implementation of the procedure, we proposed the concept of an open operating room. A glass partition separates the control room from the operating room with shutters. The room can be made visible. Behind the glass, there are chairs for the patient’s relatives. Relatives can enter the control room, voice their concerns, and offer help if the patient agrees. In case of poor tolerance of the patient to being alone in the MRI room for a long time, we allow relatives to be in the operating room and hold the patient’s hand during the procedure.
Open MRgFUS kitchen
Why we proposed the philosophy of the open MRgFUS operation room?
The participation of relatives in the treatment allows you to get the following benefits at no additional cost:
- The patient in the operating room feels supported, listens less to internal sensations, and more easily endures the operation, avoiding unjustified pressing of the stop buttons.
- Relatives see how the team performs the treatment. They understand what doctors think and how they act. Relatives see that everything is carried out conscientiously and cleanly, which motivates move doctors to make a decision.
- The team can discuss tactics with relatives and the patient. 34% of cases needed a discussion in an “extended and open Concilium.” When all employees, the patient, and relatives can express their concern about the risks of continuing the procedure. Collaboration with patients and relatives is beneficial when there is a risk of a suboptimal result, and further treatment is associated with the risk of neurological deficits. The patient and relative receive complete information about the risks and expected benefits and decide whether they will risk or limit themselves to a suboptimal result, thereby increasing patient satisfaction with treatment.
- Relatives participating in the operation feel responsible for postoperative management.
- Relatives see that you are doing well, and they will tell others about their experience. Their word of mouth is vital for the image of the commercial center.
- The sincere relationship of the MRgFUS team with relatives and the patient can reduce the likelihood of legal problems by talking through and solving problems right away.
The safety of open MRgFUS room phylosophy
Due to the absence of incisions, this operation does not require the sterility of the operating room, and relatives can be in it.
But this concept implies very high requirements for preparing a highly qualified team. With a conscientious team, there is no need to hide the kitchen, and the approach is safe for the organization.
Relatives always understand that it is unreasonable to distract the team. Usually, an attending physician in the control room answers questions from relatives and acts as a filter to not distract the piloting doctors. In our experience, 140 patients at the time of writing the chapter had no case of problems with finding patients nearby.