Need For General Anesthesia Research Articles

Microtransesophageal echocardiographic guidance of patent foramen ovale percutaneous closure

Abstract Introduction The important growth in the number of percutaneous patent foramen ovale (PFO) closure procedures requires to find alternatives to conventional guidance by transesophageal echocardiography (TEE) with general anesthesia (GA). The micro-TEE monitoring, with local anesthesia, could allow a reliable guidance with a reduced procedural length, without the need for GA. The objective of this study is to evaluate the effectiveness and safety of PFO closure guided by micro-TEE compared to conventional TEE under GA. Methods This retrospective single-center observational study included all consecutive patients admitted to our hospital, from January 2019 to June 2021 for PFO closure. The type of guidance was based on PFO’s morphological characteristics and patient’s choice. The primary endpoint was the successful implantation of at least one prosthesis without significant residual shunting (≤ grade 1). Key secondary endpoints were the procedure duration and periprocedural complications. Results A total of 237 patients (44% of female, mean age: 50 ± 14 years) were included, with TEE and micro-TEE guidance in 174 (73%) and 63 (27%) cases, respectively. Smaller devices were more frequently implanted among patients with micro-TEE compared to TEE guidance, with 59% vs. 44% respectively (p=0.04), reflecting cases selection on the basis of prior TEE. Overall, there was no case of procedural failure and the primary endpoint was obtained in 158 (91%) and 60 (95%) patients with TEE and micro-TEE guidance, respectively (p=0.27). Procedural duration was shorter with micro-TEE guidance (median time 8 (7-11)min versus 21 (16-27)min, p=0.01). The rate of peri-procedural complications was low (1.3% overall) and limited to periprocedural atrial arrhythmia, without significant differences in both groups (p>0.99). Conclusions Micro-TEE guidance may result in safe and shorter PFO percutaneous closure compared to TEE guidance with GA.These results obtained on selected patients must be confirmed on larger cohorts.

Microtransesophageal echocardiographic guidance of patent foramen ovale percutaneous closure

The important growth in the number of percutaneous patent foramen ovale (PFO) closure procedures requires to find alternatives to conventional guidance by transesophageal echocardiography (TEE) with general anesthesia (GA). The micro-TEE monitoring, with local anesthesia, could allow a reliable guidance with a reduced procedural length, without the need for GA. The objective of this study is to evaluate the effectiveness and safety of PFO closure guided by micro-TEE compared to conventional TEE under GA. This retrospective single-center observational study included all consecutive patients admitted to the Pitié-Salpêtrière hospital, from January 2019 to June 2021 for PFO closure. The type of guidance was based on PFO's morphological characteristics and patient's choice. The primary endpoint was the successful implantation of at least one prosthesis without significant residual shunting (≤ grade 1). Key secondary endpoints were the procedure duration and periprocedural complications. A total of 237 patients (44% of female, mean age: 50 ± 14 years) were included, with TEE and micro-TEE guidance in 174 (73%) and 63 (27%) cases, respectively. Smaller devices (i.e. Amplatzer PFO occluder™ 18/25 or Occlutech Figulla Flex II 23/25™) were more frequently implanted among patients with micro-TEE compared to TEE guidance, with 59% vs. 44% respectively (P = 0.04). Overall, there was no case of procedural failure and the primary endpoint was obtained in 158 (91%) and 60 (95%) patients with TEE and micro-TEE guidance, respectively (P = 0.27). Procedural duration was shorter with micro-TEE guidance [median time 8 (7–11)min versus 21 (16–27)min, P = 0.01]. The rate of periprocedural complications was low (1.3% overall) and limited to periprocedural atrial arrythmia, without significant differences in both groups (P > 0.99). Micro-TEE guidance may result in safe and shorter PFO percutaneous closure compared to TEE guidance with GA. These results must be confirmed on larger cohorts. TEE and micro-TEE durations (Fig. 1).

Systematic use of magnetic double J stent in pediatric kidney transplantation: A single-center experience.

The intraoperative insertion of a double J stent (DJS) is known to reduce urological complications and is broadly accepted in kidney transplant (KTx) patients. The magnetic ureteral DJS (mDJS) represents a valid alternative device as it can be removed without cystoscopy, using a transurethral magnet. This is of particular importance in the pediatrics, allowing us to avoid cystoscopy requiring general anesthesia (GA) in this population. To date, few data are available on the systematic use of mDJS in pediatric patients undergoing KTx. We report a retrospective analysis of 32 consecutive pediatric KTx at our center from July 2020 to December 2021. Ureteral stents remained in place for a median of 35 days (range: 12-76). Non-surgical magnetic removal of the mDJS was attempted in all cases without complications. In most cases (69%), the removal procedure was performed in an outpatient clinic. In 10 cases, the mDJS was removed in the operating room under sedation before removal of the abdominal Tenckhoff catheter. All patients were clinically followed (range: 3-15 months). We confirm the safety and feasibility of systematic use of mDJS in the setting of pediatric KTx. The systematic use of this device contributes to reduce the need for GA and the rate of hospital admission.

WE6.3 This isn't going to hurt - an ambulatory model of management of patients with subcutaneous abscesses reduces use of general anaesthetic and bed days

Abstract Aim Management of patients with subcutaneous abscesses is challenging. Once in hospital, the majority require incision and drainage (I&D), often under general anaesthetic (GA). Patients placed on emergency lists are frequently superseded, due to being systemically well, often staying overnight in hospital. We assessed how the establishment of a nurse-led, ambulatory service for I&D of abscesses reduced the need for GA, and impacted inpatient stay. Method Multiple digital sources were used to retrospectively collect data for all patients attending our centre for I&D of subcutaneous abscess during two time periods: August-October 2019 (prior to establishment of the ambulatory service) and August-October 2021 (a year after implementation of the service). Location I&D performed, mode of anaesthesia and length of stay were collected. Results In 2019, 102 patients underwent I&D; 87(85%) were drained under GA. In 2021, 73 patients were managed with I&D, but only 41(56%, p<0.001) required GA; 6(15%) cases were accommodated on a day surgery list. In 2019, 37(36%) patients were managed without overnight stay; in 2021 this rose to 46(63%, p<0.001). Extrapolating if an average of one patient requiring I&D attended each day, estimated bed days used per year dropped from 440 in 2019, to 215 in 2021. Conclusion Establishment of a nurse-led ambulatory pathway for I&D of skin abscesses safely and effectively reduces the number of general anaesthetics and inpatient bed days, potentially by half. Patients requiring anaesthetic support should be accommodated on planned day case lists where possible.

SWK-03. Neuroimaging in CNS tumours: To GA , or not to GA, that is the question.

Children with a Central Nervous System (CNS) tumour have frequent magnetic resonance imaging (MRI) scans during their disease trajectory. Younger children routinely have these performed under general anaesthetic (GA) with an associated risk and inconvenience. Our project over a two-year period was to introduce a structured programme to any child over the age of five years old to achieve an MRI scan without the need for a GA. Thirty-six patients took part. The motivation behind this project was to enhance the hospital experience for patients and their families, lessen time spent in hospital and minimise risk. In addition, there was an added incentive of cost saving and increased availability of GA scans for other specialities within the hospital setting. During the COVID pandemic, it has also resulted in a reduction of our patients requiring COVID swabs, and isolation and in turn a reduction in aerosol generating procedures. As part of the structured programme, each child had an initial assessment with the nurse specialist followed by a minimum of one play preparation session with the play specialist. Children were required to demonstrate they could follow simple instructions, engage in social stories and role-play with hospital equipment and specialised resources. During these sessions, the children visited the MRI department where they practiced lying flat on the MRI bed as it moved into the scanner. Over the two-year period, of the total number of MRI scans performed, the amount of MRI scans requiring a GA reduced from 41% to 31%. The quality of the MRI scans was scrutinised and shown not to be significantly affected. In summary, by introducing a structured programme, it is possible to significantly reduce the need for GA in children requiring CNS imaging as part of their tumour journey.

Factors determining the need for general anesthesia to deliver dental treatment for adults with intellectual and developmental disabilities.

Aim:To investigate factors determining the need for general anesthesia (GA) to deliver dental treatment for adult people with intellectual and developmental disabilities (IDD).Methods:This study involved a retrospective review of medical records of adult patients with IDD who received dental treatment under GA at Tabuk Specialist Dental Center, Saudi Arabia, between 2018 and 2020. Demographic characteristics and dental-related details, level of cooperation, and methods of delivering dental treatment were collected.Results:A total of 86 adult patients with IDD were included. The mean age of the study participants was 34.8 years (standard deviation [SD] 6.5), and the majority were males (n = 47, 54.7%). Eighteen patients had aphasia (20.9%), 16 had epilepsy (18.6%), and 10 had cerebral palsy (11.6%). Most dental treatments delivered were complex dental treatments (n = 39, 45.3%) followed by dental extraction (n = 25, 29.1%), and non-surgical periodontal therapy (n = 22, 25.5%). Females had higher odds of undergoing GA compared to males (Odds ratio (OR) =6.79, 95% Confidence intervals (CI): 1.62–28.41). Furthermore, patients who had aphasia had higher odds of undergoing GA compared to patients who had no medical conditions (OR = 14.03, 95% CI: 1.05–186.7).Conclusion:Being female or having aphasia are independent factors related to the need for GA to deliver dental treatment for Saudi adults with IDD.

Auditory brainstem response testing using intranasal dexmedetomidine sedation in children: a pilot study

Objective Auditory brainstem response (ABR) is used to determine hearing thresholds in children who cannot undergo behavioural testing. Children must remain still during testing, with general anaesthesia (GA) in theatre required for those who cannot. We developed a protocol whereby an ABR was undertaken in a ward environment using only intranasal dexmedetomidine for sedation. Design Prospective data were collected including the time of sedation onset, ABR duration and arrival to discharge time was recorded and feedback was requested using a questionnaire. Study sample Twenty-nine consecutive patients routinely undergoing an ABR. Results From this pilot study, we demonstrated that intranasal dexmedetomidine could be used successfully to administer safe sedation to all twenty-nine children undergoing an ABR in a ward environment as opposed to theatre. Conclusions This allowed for faster time to discharge compared to GA, produced what was felt to be a better quality ABR trace, better utilization of a theatre slot, negated the need for GA in a child and created a less stressful experience for both parent and child according to information from feedback questionnaires.

An objective criteria used to support a practitioner's decision between sedation versus general anesthesia for the dental treatment of uncooperative pediatric patients

This purpose of this study was to create a criteria and assess its performance with the results as to use of conscious sedation versus general anesthesia for dental care of uncooperative pediatric patients. A retrospective study was designed to include children who received dental care under GA (General Anesthesia) or CS (Conscious Sedation) over a one year period in Newark, NJ. A study sample size of 80 children was created according to a power analysis used to yield a sample with 80% power at the 0.05 significance level. Children were divided into two groups. 35 subjects were in the CS group and 45 in GA group. For each child; the total score of the suggested criteria was calculated using the collected data. The suggested criteria combined seven scales, the criteria's total score is the sum of the seven scales' scores. The scale was designed such that a higher score would indicate the need for GA rather than CS. The criteria was designed to indicate the use of GA when the total score is 16 points or higher. This evaluation showed that there is a positive correlation between the proposed criteria and the decision made retrospectively to use GA versus CS for uncooperative children needing dental care. The scale is a valid indicator of the need for GA versus CS, except for a child's age.

In Response.

In Response.

Retrograde ureteric stent exchange in the female oncology patient by interventional radiology: the experience of a single tertiary referral centre.

Double-J stents are used to treat ureteric outflow obstruction. Deployed in antegrade or retrograde fashion, they relieve ureteric obstruction in several conditions including ureteric calculi, strictures and malignancy. Traditionally exchanged in an operating theatre (OT) under general anaesthetic (GA), more recently described is the technique of using fluoroscopic guidance under sedation. To assess the efficacy and safety of retrograde double-J stent exchange in an interventional radiology (IR) setting in a tertiary oncology referral centre over a 7-year period. Clinical data on 460 double-J stent exchanges in 126 female patients was acquired from the hospital electronic patient record. Four fellowship-trained interventional radiologists performed the procedures. A standard approach was used in conjunction with conscious sedation using midazolam and fentanyl. Use of the technique with certain anatomical variations is also described. Technical success rate was 96%. The main reasons for failure included failure to snare the stent (1.8%) and patient discomfort (1.1%). The overall complication rate was 5%: 5 category 1 (minor) and 18 category 3 outcomes, with the latter group requiring further intervention. Average screening time was 9.65min and the average radiation dose was 2018.24mGy/m2. We also demonstrate the successful use of this method in patients with unusual anatomy and ileal conduits. Fluoroscopic-guided retrograde double-J stent exchange is a safe and effective procedure that can be performed with a high degree of success using equipment and techniques used in daily IR practice. This approach precludes the need for GA, reduces OT utilisation and is well tolerated in a patient group for whom this procedure is typically palliative.

Ultrasound-guided serratus anterior plane block for subcutaneous implantable cardioverter defibrillator implantation using the intermuscular two-incision technique.

Operative anaesthetic requirements and perioperative discomfort are barriers to wide adoption of the subcutaneous implantable cardioverter defibrillator (S-ICD) system, especially when the intermuscular technique is used because of the greater amount of tissue dissection. The procedure is most commonly performed under general anaesthesia (GA). There is growing interest in transitioning away from the routine use of GA and towards several alternative anaesthesia modalities for the S-ICD implant procedure without the involvement of an anaesthesiologist. We assessed the feasibility of ultrasound-guided serratus anterior plane block (US-SAPB) in patients undergoing S-ICD implantation with the intermuscular two-incision technique. The study population included 38 consecutive patients (84% male; median, 53 [46-62] years) who received S-ICD implantation using the intermuscular two-incision technique. All procedures were performed under US-SAPB and conscious sedation without the involvement of an anaesthesiologist. The average procedure time was 67 ±14min. No patient experienced significant haemodynamic changes or oxygen desaturation during the period of the US-SAPB procedure and sedation; there was no need for pharmacological interventions. The entire procedure was well tolerated without discomfort or complications and with no need for GA, except in one (2.6%) patient who received GA with a laryngeal mask airway. Patients always remained able to respond appropriately to neurological monitoring during the S-ICD implantation procedure. There were no procedure-related complications. US-SAPB and the intermuscular two-incision technique may be a promising safe and feasible combination for S-ICD implantation, overcoming the potential barrier to wider S-ICD adoption in clinical practice.

Lacrimal trephine vs punch in external dacryocystorhinostomy: The surgeon’s choice

Aim: A prospective comparative study to describe the surgical outcomes of external DCR using Kerrisons punch vs Lacrimal trephine. Materials and Methods: A prospective comparative study involving 56 consecutive patients of age group 30-70 years over a period of 3 years who were randomly divided into two Groups. Group 1(n=28) underwent external conventional DCR using kerrisons punch as against group 2 (n=28) where trephine was used for osteotomy. Result: Procedure success rate among Kerrisons group was 92.85% (26) vs 89.28% (25) in lacrimal Trephine group which is found to be comparable. Overall success rate was 91.07% (51). Need of general anaesthesia, more bleeding, longer operative time in group 1versus higher chance of nasal mucosal damage in group 2 was noticed. Patients were followed up for six months after surgery. Conclusion: Kerrison punch showed almost comparable success rate to lacrimal trephine group but higher operating time for external DCR. Lacrimal trephine is relatively easier to perform, requiring shorter duration at skilled hands. Keywords: DCR, Trephine, Lacrimal, Punch.

P996Early experience of transnasal micro-transesophageal echocardiography to guide left atrium appendage closure under conscious sedation

Abstract Introduction Percutaneous left atrial appendage closure (LAAC) is typically performed utilizing transesophageal echocardiography (TEE) and fluoroscopy under general anesthesia (GA) or intracardiac echocardiography (ICE) under conscious sedation. Transnasal microtransesophageal echocardiography (micro-TEE) is a recently described technique to guide structural heart interventions eliminating the need for GA, which is beneficial for all, especially older patients. In this series, we report our initial experience with this novel technique to guide LAAC. Methods and results Between June 2018 and January 2019, we performed 30 consecutives LAAC (mean age 80,2 years old) with the Amplatzer AMULET in whom we considered using transnasal micro-TEE under conscious sedation instead of TEE under GA. All patients had a CT prior to the procedure to assess anatomy suitability and to rule out thrombus as well as a follow-up CT performed at 3 months post-LAAC to confirm complete sealing. Three patients had TEE instead of micro-TEE for various reasons (patient preference, cognitive impairment, INR >2). We observed one cross-over to TEE+GA because of a failed esophageal intubation under conscious sedation. Device implantation success rate was 100%. Imaging quality was quoted either good or excellent in 25 of the 26 patients with the remaining being quoted as suboptimal. Patient tolerance was either good or excellent in 24 of the 26 cases. There were five epistaxis noticed, one requiring nasal packing. No device embolization, no significant peri-device leak, no tamponade occurred in any patient during this period. At 3 months, there was no prosthesis thrombosis observed and 23% (6/26) had partial opacification of the LAA behind the prosthesis. Conclusion In this series, transnasal micro-TEE was feasible, safe, well tolerated and provided sufficient imaging quality to guide LAAC with the Amplatzer AMULET under conscious sedation. The cheaper cost and the wider field of view of micro-TEE over ICE are potential advantages that could impact the organization of LAAC programs especially when these interventions are planned in the elderly in whom GA carries a significant risk.

One-year experience of the micro trans esophageal probe in cardiac structural interventions

Transoesophageal echocardiography (TEE) under general anesthesia (GA) is the reference technique to guide most of transcatheter cardiac structural interventions (TCI). However, the need for GA represents an important limitation in the context of the dramatic increase of this activity. Multiplane micro TEE probe (MMt) has recently emerged as an alternative imaging technique for procedural guidance that would not require GA. The aim is to evaluate the feasibility of the use of MMt to guide TCI without GA. We report our 1-year experience of TCI guidance with MMt used during the whole procedure under conscious sedation or without sedation in specific situations requiring unplanned TEE guidance. MMt was used during the following interventions: – Patent Foramen ovale closure ( n = 73), – Guidance of difficult transseptal catheterization during percutaneous mitral commissurotomy ( n = 6), – Selected cases of assessment after TAVI requiring TEE to evaluate the final result (position, paravalvular leak) ( n = 5), – MitraClip procedure with failure of conventional TEE ( n = 1). Overall, the tolerance of the probe and the comfort of the patients were excellent. There was neither complication related to its use, nor conversion to GA and conventional TEE. Although the quality of imaging might be inferior to that of conventional TEE, the information was sufficient to guide the procedures in all cases. The absence of GA significantly shortened procedural time and interval between procedures. This preliminary experience illustrates the role of MMt without GA during specific TCI, improving procedural time while preserving the comfort of the patients. In addition MMt appears particularly useful in patients requiring unplanned TEE during TCI. Despite some limitations, as the lack of 3-D imaging, we anticipate that MMt will play an important role in the context of increasing demand in interventional guidance.

Left atrial appendage closure with the Watchman device using intracardiac vs transesophageal echocardiography: Procedural and cost considerations

Imaging guidance for left atrial appendage (LAA) closure (LAAC) conventionally consists of transesophageal echocardiography (TEE) and fluoroscopy under general anesthesia (GA). Intracardiac echocardiography (ICE) can eliminate the need for GA, expedite procedural logistics, and reduce the patient experience to a simple venous puncture. The purpose of this study was to define optimal ICE views and compare procedural parameters and cost of ICE vs TEE during LAAC with the Watchman device. Optimal ICE views of the LAA for Watchman implant were delineated using Carto-Sound and 3-dimensional rendition of the LAA in 6 patients. Procedural and financial parameters of 104 consecutive patients with standard indications for LAAC undergoing Watchman implant using ICE guidance through a single transseptal puncture (n = 53 [51%]) were compared with those of TEE-guided implants (n = 51 [49%]) in 3 centers. Clinical characteristics were similar between the 2 groups. Total in-room, turnaround, and fluoroscopy times all were shorter using ICE (P <.05) under local anesthesia compared to the TEE group. Implant success was 100% in both groups without peri-device leaks or procedural complications. Follow-up TEE showed no significant peri-device leak in both groups. Total hospital charges for ICE with local anesthesia vs TEE were similar, as were total hospital direct and indirect costs. Professional fees were significantly lower with ICE and local anesthesia than with TEE because the charge of anesthesia staff was avoided. ICE-guided Watchman implant is safe, feasible, and comparable in cost to TEE during LAAC with a Watchman device but avoids GA and expedites procedure turnaround.

Wide-Awake Flexor Tendon Repair Under Tumescent Injection

Background. Flexor tendon injuries are frequent, due to variable hand activities, and the repair is challenging to hand surgeons, especially in zone II, because of the coexistence of two tendons within a tight fibro-osseous tunnel. Flexor tendon repair under tumescent infiltration provides anesthesia and a bloodless field, so that no tourniquet or sedation is needed. Aim of study. The goal of this study was to identify a surgical adjustment and intraoperative total active movement examination of the repaired tendon so that no gapping is formed, and smooth gliding is obtained, avoiding tendon rupture and producing an optimal range of motion. Patients and method. From January 2016 to April 2017, 9 patients (17 tendons), with a mean age of 31.8 years, presented within 3 to 14 days of injury to zone I or zone II of their flexor tendons. Tendon repair was done under tumescent infiltration (lidocaine 1% with adrenaline 1:200,000) only, with no tourniquet or sedation, and with an intraoperative total active movement examination. Result. After 6 months of follow up, all the patients had excellent range of motion according to the Boyes outcome scale, and none showed signs of postoperative tendon rupture. Conclusion. Tumescent infiltration for flexor tendon repair allows intraoperative surgical adjustment and total active movement examination, which will minimize postoperative rupture and adhesion. This procedure will also facilitate the surgeon’s work by eliminating the need for general anesthesia or sedation; however, this procedure is not applicable for children, major trauma, or those who are mentally challenged.

Age-appropriate preparations for children with cancer undergoing radiotherapy: A feasibility study.

The aim of this study was to test age-appropriate information and preparation procedures for children with cancer undergoing radiotherapy (RT) for feasibility and effectiveness in terms of the need for general anesthesia (GA) and anxiety. In a quasi-experimental controlled clinical trial, 17 children aged 3-18 years receiving age-appropriate preparation were compared with 16 children in a control group. Feasibility in terms of recruitment, compliance, and acceptability was assessed. Effectiveness was assessed by the number of children who underwent treatment without GA and their respective fractions and validated instruments measured the children's anxiety and emotional behavior. The preparation parts were delivered as intended without any additional personnel and without dropouts in the intervention group (IG) and therefore found feasible and acceptable. No statistic significances were found concerning the number of children receiving GA or anxiety. However, three children planned for GA in the IG completed their treatments, including 73 fractions awake. Children receiving GA, regardless of group, showed significantly higher negative emotional behavior. Giving children individualized preparation may decrease the need for GA during RT, which gives benefits in terms of fewer risks and restrictions in life for the child and lower costs for health care.

Use of general anaesthesia in paediatric dentistry: barriers to discriminate between true and false cases.

The use of general anaesthesia (GA) has shown significant increase in child dental patients. This study aimed to assess whether behaviour management strategies can be the effective methods for decreasing the need for GA and its over-utilisation in paediatric dentistry. The patients (n = 240) aged 3-6 years old were selected from referrals by paediatric dentists (PD) or general dentists (GD) for dental treatment under GA. Each child's behaviour during first and subsequent appointments was assessed using the Frankl Behaviour Rating Scale. A first visit included clinical examination and fluoride therapy. In all sessions, a hierarchy of anxiety-reducing behaviour guidance strategies was implemented over nine steps in a logical treatment order. Overall, 47.5% of children referred for dental treatments under GA were retrained to be treated routinely. False referrals were significantly higher in GD compared to PD group. 80.0% of the referred children by PD and 6.7% of those referred by GD were true GA cases and still needed GA. 20.1% of retrained children and 67.4% of true GA cases received conscious sedation. There was no significant change in the frequency of children considered uncooperative as the years of experience increased among GD, while this value was significant for PD. The findings may highlight the importance of using behaviour management techniques thoroughly prior to referring an uncooperative child for treatment under GA, and may discourage its over-utilisation. Specifically, these skill sets and their efficient practice should be improved among general dentists.

Regional anaesthesia – the bride at last?

Regional anaesthesia – the bride at last?

Mock MRI: reducing the need for anaesthesia in children

With a longer waiting list for paediatric MRI performed under general anaesthesia (GA) and considering safety concerns, the Royal Children's Hospital Brisbane established a mock MRI service. The aim of this service is to reduce the requirement for MRI under GA. The objective of this study was to test the hypothesis that the percentage of children ages 3 years to 14 years in the study period that required general anaesthesia would be less with mock MRI when compared to standard practise. A retrospective audit of clinical data was conducted to examine the impact of mock MRI on the GA rate for clinical MRI. Results indicated the addition of a mock MRI reduced the need for GA most significantly for children ages 3 to 8 years. In this age group, the rate of GA was 16.8% lower than that of the non-mock MRI group (P = <0.05). Mock MRI reduces the need for GA in children with the greatest effect evident in children aged between 3 and 8 years.