Extra Topic 3.7 -- Laryngeal Polyps

Question 1

What possible complications would you anticipate?

(A 6-year-old female is scheduled for laser treatment of laryngeal polyps.)

Answer 1

In this case, I would anticipate the possibility of difficult intubation, difficult mask ventilation, airway obstruction, airway fire, bronchospasm, laryngospasm, and corneal or tissue burns.

Additionally, if a jet ventilation technique is employed, there is increased risk of barotrauma and/or distribution of the papilloma virus into lower airways.

Finally, operating personnel are at risk of inhaling vaporized debris and eye injury, necessitating the use of special surgical masks and laser-specific eye goggles.

Therefore, to minimize the risk of complications, I would ensure the presence of adequate airway equipment, laser protective wear, skilled personnel, and emergency medications.

I would also take precautions to avoid and/or address an airway fire, such as –

using a laser-resistant ETT, having a syringe of normal saline available (to douse an airway fire), delivering no more than 30% oxygen during laser use, and preparing a plan of action to deal with an airway fire.

Question 2

The ETT ignites during laser treatment.

What would you do?

(A 6-year-old female is scheduled for laser treatment of laryngeal polyps.)

Answer 2

I would alert the surgical team, stop ventilation, disconnect the oxygen supply from the airway, and remove the endotracheal tube.

If the flame persists, I would flood the surgical field with saline.

Once the fire has been extinguished, I would ventilate with 100% oxygen, reintubate the patient, and perform bronchoscopy to rule out foreign bodies and assess the extent of lower airway damage and edema.

Depending on the extent of the injury, I would consult a pulmonologist and monitor the patient with serial chest x-rays and continuous pulse oximetry.

Question 3

Could this have been prevented?

• (The ETT ignites during laser treatment.)*
• (A 6-year-old female is scheduled for laser treatment of laryngeal polyps.)*

Answer 3

Not necessarily, but there are multiple steps that can be taken to reduce the risk of airway fire, including –

using a laser-resistant endotracheal tube, decreasing the concentration of gases that support combustion, filling the ETT cuff with saline, and limiting the intensity and duration of laser treatment.

Other options include –

employing an apneic anesthetic technique without an endotracheal tube, or utilizing a jet ventilator to avoid the need of an endotracheal tube in the oropharynx during laser use.

Question 4

What does Laser stand for?

(A 6-year-old female is scheduled for laser treatment of laryngeal polyps.)

Answer 4

The word laser is an acronym for light amplification by stimulated emission of radiation.

Laser energy rapidly increases the temperature of tissue water, denatures proteins, and results in vaporization of the target tissue.