Flashcards in Laser ppt Deck (55)
Loading flashcards...
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
