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31

Nd-YAG laser properties
WL 2064

sHorter WL= Higher freq= Higher energy

32

Lasers are freq used in airways for what sx's

laryngel papillomas
tracheal scaring
vascular malformations
neoplasms
idiopathic subglottic stnosis

33

Risk of lasers in sx

loss of AIRWAY
FIRE
burns
eye damage

34

Preoperative preperation for laser sx

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

35

Airway concerns with laser

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

36

Induction concerns?

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

37

OSA is who princilple

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

38

Causes of OSA

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)

39

Maintenance for laser airway sx

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

40

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

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

41

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

continually assess integrity of cuff
don't breath laser olume

42

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

40% or less (preferable 21%)

43

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

N2O
supports combustion

44

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

bottle of saline or water

45

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

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

46

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

yep

47

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

be prepared to extinguish and treat
be prepared to emergently extubate

48

what do you do for an airway fire?

-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

49

what 3 things are needed for a fire

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

50

what meds do you want to give post airway fire?

corticosteroids
Antibiotics

51

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

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

52

Postop risk of laser sx in airway

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

53

A laryngospasm is caused by what?

vocal cord irritation

54

what is the primary muscle responsible to laryngospasms

cricothyroid

55

Treatment of laryngospasms

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