Laser ppt

Question 1

What does LASER stand for

Answer 1

Light
Amplification
by
Stimulated
Emission
of
Radiation

Question 2

what is a device that controls the way energized atoms release photons

Answer 2

Laser

Question 3

what are the 3 main properties of a laser that make if very different from other lights

Answer 3

monochromatic
coherent
directional

Question 4

what property of a laser is that it contains one specific wavelength of light (one specific color).

Answer 4

monochromatic

Question 5

the wavelength of light is determined by what?

Answer 5

the amount of energy released when the electron drops to a lower orbit

Question 6

what property of a laser describes how it is organized- thus each photon moves in step with the others, this means that all the photons have wave fronts that launch in univision

Answer 6

coherent

Question 7

which laser property is that a laser light has a very tight beam and is very strong and concentrated

Answer 7

directional
(a flashlight in contrast releases light in many directions, the light is very weak and diffuse)

Question 8

Carbon dioxide laser properties (2)

Answer 8

invisible
marked with a helium-neon aiming beam

Question 9

what is the Carbon dioxide laser used for

Answer 9

upper airway sx

Question 10

is carbon dioxide laser common

Answer 10

yes,
very common

Question 11

Nd-YAG laser stand for what?

Answer 11

neodymium-yttrium aluminum-garnet laser

Question 12

Nd-YAG laser properties (1)

Answer 12

short wave length allows transmission by fiberoptics

Question 13

Nd-YAG laser is used for what sx's

Answer 13

distal tracheobronchial tree and retina sx

Question 14

KTP laser stand for what?

Answer 14

Potassium-titanylphosphate laser

Question 15

KTP laser can be transmited by what?

Answer 15

fiberoptics

Question 16

KTP laser is used in what sx's

Answer 16

neurosurgical and
otolarygeal

Question 17

Argon Laser can be transmitted by what

Answer 17

fiberoptics

Question 18

Argon laser is used in what sx's

Answer 18

neurological, retinal, and otolaryngological

Question 19

7 wavelengths in order of power (weakest to most powerful

Answer 19

radio
microwave
infrared
visible
ultraviolet
x-ray
gamma ray

Question 20

with laser wavelengths longer wavelengths= what?

Answer 20

lower freq and lower energy
(all start with L)

Question 21

with laser wavelengths shorter wavelengths= what?

Answer 21

higher freq and higher energy
(for jake sHorter= Higher and Higher) : )

Question 22

frequancy is inversly proprtional to what??

Answer 22

wavelength
the higher the frequency the smaller the wavelength

Question 23

what has a higher freguency?
KTP Wave length is 532
or
Nd:YAG wave length 1064

Answer 23

KTP
remember
freq is inversly proportional to wave length
the longer the wavelength the lower freq

Question 24

which laser is for deep tissue? and why?

Answer 24

Nd-YAG
b/c of near infrared I guess????

Question 25

what is the only laser that wet tissue can protect pt (like a wet towel)

Answer 25

CO2 laser

Question 26

what 2 lasers are absorbed by Hgb and melanin or other similar pigments? transmitted through clear substances.
tissue penetration 0.5-2 mm

Answer 26

Argon
KTP

Question 27

which laser is more readily absorbed by dark tissue?
transmitted through clear fluids
tissue penetration 2-6 mm

Answer 27

Nd-YAG

Question 28

which laser is strongly absorbed by water, and thus by all tissue, pigmented or not. tissue penetration <0.5mm

Answer 28

CO2

Question 29

the greater the wavelength = the _______ absorption by water

Answer 29

greater
CO2 greatest WL 10,600

Question 30

CO2 laser properties?
WL 10,600

Answer 30

Longer WL= Low freq= Low energy

Question 31

Nd-YAG laser properties
WL 2064

Answer 31

sHorter WL= Higher freq= Higher energy

Question 32

Lasers are freq used in airways for what sx's

Answer 32

laryngel papillomas
tracheal scaring
vascular malformations
neoplasms
idiopathic subglottic stnosis

Question 33

Risk of lasers in sx

Answer 33

loss of AIRWAY
FIRE
burns
eye damage

Question 34

Preoperative preperation for laser sx

Answer 34

antisialagogue
Eye protection for personnel and pt
Laser tube or ETT wrapped with laser tape

Question 35

Airway concerns with laser

Answer 35

shared airway
airway obstruction (foreign body, edema, obstructive mass/lesion)

Question 36

Induction concerns?

Answer 36

airway patency
RSI vs smooth IV or mask
OSA
(must preoxygenate (may need oral airway))
(sevo least irritating to airway)

Question 37

OSA is who princilple

Answer 37

burnelli's (spelling???)
thats why we give CPAP they lost pressure

Question 38

Causes of OSA

Answer 38

floppy upper airway
redundent fat deposits (in lateral pharyngeal walls)
sleep and anesthesia- increased pharyngeal musculature relaxation and posterior tongue displacement
airway narrowing (bernoulli effect)

Question 39

Maintenance for laser airway sx

Answer 39

PREVENT LOSS OF AIRWAY
with shared airway
-communicate with surgeon
-closely monitor breath sounds and EtCO2
PREVENT BURN INJURY
don't look into laser
confirm standby mode
-know aiming beam vs power beam
don't allow laser on drapes
PREVENT EYE INJURY
PREVENT INHALATION INJURY

Question 40

what do you want to do to protect the pt's eyes from laser

Answer 40

lub eyes
tape shut
saline soaked pads (CO2 only)
Laser goggles (not glasses)

Question 41

how do you prevent inhalation injury? (to yourself and pt)

Answer 41

continually assess integrity of cuff
don't breath laser olume

Question 42

when doing airway sx with a laser what do you want to do with FiO2?

Answer 42

40% or less (preferable 21%)

Question 43

When doing airway sx with a laser what VAA do you want to avoid? and why?

Answer 43

N2O
supports combustion

Question 44

when doing airway sx with a laser what must you always have immediately available?

Answer 44

bottle of saline or water

Question 45

when doing airway sx with a laser what 2 things are important about the OETT tube

Answer 45

use a laser or protected ETT
fill endotracheal cuff with saline or dye
use smallest allowable tube for surgical exposure and ventialation
usually 5.5-6.5

Question 46

can you wrap a ETT in laser foil to protect from laser

Answer 46

yep

Question 47

what 2 things do you want to be prepared for duing airway laser sx (in case of fire)

Answer 47

be prepared to extinguish and treat
be prepared to emergently extubate

Question 48

what do you do for an airway fire?

Answer 48

-stop ALL gas flows
-cut pilot tube
-extubate pt
__________________
-extinguish with water or saline
_____________________
-reintubate pt
-ventilate with air only until remaining no remaining fire is confirmed
_______________________
- ventilate with 100% O2
______________________
-assess (DL and FOB) larynx, trachea, bronchiole tree for damage

Question 49

what 3 things are needed for a fire

Answer 49

oxidizer (N2O or O2)
fuel (drapes or ETT)
Ignition source (laser or Bovie)

Question 50

what meds do you want to give post airway fire?

Answer 50

corticosteroids
Antibiotics

Question 51

No fires back to regular sx with laser
what are poss complications/ concerns of extubation

Answer 51

-possible deep extubation
- airway blood may remain despite sxn
-laryngospasm
-be sure any saline pledgets and throat packs have been removed by surgeon

Question 52

Postop risk of laser sx in airway

Answer 52

laryngospasms (due to irritation and remaining blood)
-stridor, coughing, bronchospasm

Question 53

A laryngospasm is caused by what?

Answer 53

vocal cord irritation

Question 54

what is the primary muscle responsible to laryngospasms

Answer 54

cricothyroid

Question 55

Treatment of laryngospasms

Answer 55

-CPAP by mask (attempt positive pressure ventilation <20cm H2O
-jaw thrust (at angle of Ramus-accupressure point)
-Succinylcholine if needed