Lasers
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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)