Laser stands for _____?
Light Amplification by Stimulated Emission of Radiation
What is the relationship of wavelength to power?
Shorter the wavelength, higher the frequency, higher the power.
Name 2 'weak' medical lasers and their uses
CO2 - Upper airway
Nd:YAG - distal tracheobronchial tree and retina
Note: The slides do say that Nd:YAG is a “powerful” laser, but my justification here is that while it is approximately 10X more powerful than the CO2, when compared to the other lasers (KTP, Argon) on the chart 3 slides prior, the Nd:YAG is a RELATIVELY lower-power laser.
Name 2 'powerful' medical lasers and their uses.
KTP - Neurosurgical and otolaryngeal
Argon - Neuro, retinal, otolaryngeal
What is the color of a CO2 laser, Nd-YAG laser, He-Ne laser. Are they visible?
CO2: Invisible (far infrared)
Nd-YAG: Not visible (Near infrared)
He-Ne: Red (used as aiming beam)
The first 2 are not visible to the naked human eye; the 3rd is.
Name 3 main risks associated with laser use.
I got 4!
Fire
Burns
Eye Damage
Loss of Airway
Laser may be used for what type of surgeries of particular involvement with anesthesia providers?
Airway surgeries:
- laryngeal papillomas
- tracheal scarring
- vascular malformations
- neoplasms
- idiopathic subglottic stenosis
What type of anesthesia is recommended for laser airway surgery?
-
VAA (Sevo) or TIVA
-
Low FiO2 (40% or less, 21% preferred)
-
Complete neuromuscular blockade
-
Avoid N2O
What is the preparation for a laser airway case?
-
Anti-sialagogue
-
Eye protection for OR personnel AND patient
-
Laser tube or ETT wrapped with laser tape (smaller tube size)
-
Bottle of saline/water immediately available
What is the maintenance technique of an above case? (this one's a little long, sorry, it's all the crap that was in the slide...)
-
Complete neuromuscular blockade
-
Routine monitoring
-
Close monitoring of breath sounds and EtCO2
-
Do not look into laser
-
Do not allow laser to lay on drapes
-
Be aware of when laser is in use and confirm in standby mode
-
Eye Protection (lube pt eyes, tape shut; saline soaked eye pads; laser goggles on pt; appropriate laser glasses on all OR personnel)
-
Continually assess cuff integrity
-
Do not breathe laser plume
How do you treat an airway fire?
-
Stop ALL gas flow, CUT pilot tube, EXTUBATE
-
Extinguish with H2O or NS
-
RE-INTUBATE emergently and VENTILATE with AIR ONLY until confirmation of no remaining fire
-
THEN VENTILATE with 100% O’s
-
Assess larynx, trachea, bronchiole tree for damage
What is the emergence, extubation technique?
-
Deep extubation
-
Airway blood may remain despite suctioning
-
Ensure all pledgets or throat packs have been removed
What are the postop risks?
-
Laryngospasm d/t irritation or remaining blood
-
Stridor
-
Excessive coughing
-
Bronchospasm
INTERVENE QUICKLY!!!
What 3 things are needed for a fire?
-
Fuel
-
Oxidizer
-
Ignition source
Most common laryngospasm muscle?
Cricothyroid (lengthens and tenses cords)
