1. Chris Bowen T? May 27 th 2011 Anesthesia Keyword Presentation

2.  Reported in 0.4-1.5% of laser airway cases  Believed to be grossly underreported › Risk of laser contacting ET tube 1:2  Inception › Direct illumination › Reflected › Particles  3 things every growing fire needs: › Ignition source  laser, electrocautery › Oxidant  O 2, Nitrous Oxide › Fuel  ET tubes, drapes, etc.

3.  Seeding  Cuff puncture releases more oxidant into field  The “blowtorch” effect  Airway trauma › Smoke and debris inhalation  Death

4.  D/C oxygen and extubate  Douse flames with saline  Mask ventilation › Assess feasibility of reintubation for…  Bronchoscopy to assess extent of injury › Supportive care › Consider leaving tube if not burning  Admit patient to ICU

5.  OR prevention › Proper eye protection › Wet towels and minimal draping › Matte/dull finished or blackened instruments › Signs posted › Extinguisher checked and in room › Laser set on pulse not continuous › Laser set on “standby” mode

6.  Anesthesia Preventions › Dentures and nasogastric tubes removed › Co-morbidities › Technique  Jet, apneic, spontaneous ventilation › Tube  Type  Metal vs. rubber vs. PVC  Coverings › Cuff preparation

7.  Tapes › 3 major types › Inexpensive  Cuff filled with saline vs. air › Mini-extinguisher effect › Methylene blue dye  Tubes › Metal  interlocking rings of stainless steel › Rubber  soft, usually without cuff › PVC  garden variety

8.  46% prefer laser-safe ET, 26% prefer Jet Ventilation, 16% apneic, 12% spontaneous  Sosis and Dillon  Tapes › Copper demonstrated no combustion at 60 sec. › Not FDA approved › Proper application is key  Limit flexibility  Increase diameter  Can come loose  Cuffs › Saline filled cuff perforation reduced combustion by 80% › Dye allows for quick assessment of cuff integrity › Dual cuffs made extubation problematic  Tubes › Metal is resistant not impervious  increased trauma upon insertion › PVC very resistant  Taping or covering recommended  Application must be precise › Rubber most flammable*  Blood, mucus, and tissue increased combustion rates up to 60%  The YAG laser ignited all materials within 6 sec

9.  Metal tubing is safe and effective › Resistant not impervious  Cuffs should be filled with saline and dye  Copper tape has superior resistance when compared to other tapes and coverings  Nothing withstands the YAG

10.  LMAs  Increased muscle relaxants  Are all lasers created equal?  Metallic tape vs. laser-guard coverings  F i O 2 and inhaled anesthetic levels  Tracheostomy

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