Table 1: Anesthetic regimen in MRgFUS.

IndicationMedication/treatmentSpecial considerations

Pain preventionIntravenous paracetamol 1 g with dexamethasone 12 mg, unless fasting blood sugar >120 mg/dlOne hour before the procedure
Nausea preventionIntravenous granisetron 3 mg or ondansetron 4 mg, or metoclopramide hydrochloride 10 mg in essential tremor patients. If protracted, dexamethasone 12 mg, unless fasting blood >120 mg/dlOne hour before treatment
Pain from pressure of the silicone membraneEMLA lubrication of the skull before fitting the silicone membrane30 minutes before membrane placement
Pain from pins of the head frameLocally injected lidocaine 2% and bupivacaine 0.5%, at each pin siteImmediately before pin insertion
BackacheUsually not needed. May administer intravenous paracetamol 1 g, dipyrone 1 g, or ketorolac 30 mgUse of specialized cushion that flexes legs and reduces pressure on the lower back
Neck painUsually not needed. May administer intravenous paracetamol 1 g, dipyrone 1 g, or ketorolac 30 mgUse of small cushion below the neck
AnxietyNoneEmploying nonpharmacologic strategies
Nausea during treatmentIntravenous ondansetron 4 mgA few drops of lemon juice may be tried
VomitingSuctionUrgent call for help
VertigoNoneReassurance since transient
MiscellaneousOxygen 2-3 l/min via the nasal prong. Emergency stop button that shuts down sonication and calls for help is given to the patient

EMLA: eutectic mixture of local anesthetics; mg: milligram; dl: deciliter; ml: milliliter; l: liter; min: minute.