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The provision of safe sedation or anaesthesia for magnetic resonance imaging (MRI) presents unique challenges to the anaesthetist. Restricted patient access and the need for remote monitoring with the anaesthetist ideally outside the imaging room necessitates that minimal anaesthetic monitoring standards are adhered to. However, the intense magnetic field and the radio-frequency currents used to generate images require the use of special magnetic resonance (MR) compatible equipment. This must perform adequately within the magnetic field but must not pose a threat to patient safety or degrade the MR image. Risks such as ferromagnetic objects becoming projectile near the magnetic field or the effect of the magnetic field on pacemakers and other surgical implants mean that systems should be in place to safeguard the health and safety of both patients and staff. This article addresses these issues and considers the implications for anaesthetists of developments in MR.