Laser Airway Surgery

Question 0

Characteristic of CO2 laser

Answer 0

CO2 - invisible beam

Helium-neon – marker

beam Actions - cuts and cauterizes

Beam reflection can cause secondary injuries

Beam power = kills nerves instantly so withdrawal response is delayed

Question 1

What does laser stand for

Answer 1

Light Amplification by Stimulated Emission of Radiation

Question 2

Characteristics of CO2 laser wavelength

Answer 2

10,600 nm

risk of Fire and heat injury

blocked by cornea, protects the retina but produces Heat injury to anterior eye

Question 3

What is the YAG laser

Answer 3

Yttrium-Aluminum-Garnet Invisible beam with helium-neon marker beam

Absorbed by dark pigments (Hemoglobin)

Question 4

What are the risk of a YAG laser wavelength

Answer 4

Risk are from 3 elements in the laser

355 nm – blocked by cornea, Can cause: Cataracts, skin cancer

266 nm – blocked by cornea, Can cause: Cataracts, skin cancer

1064 nm – transmitted by cornea: can cause severe retinal damage

Question 5

Name some endotracheal tubes and tracheostomies that are used with laser airway surgery

Answer 5

Red rubber ETT with Merocel wrap

Xomed ETT

laserflex ETT

Jackson tracheostomy tube (uncuffed) (All metal tracheostomy)

Question 6

What are 2 adjunct materials used for laser airway ETT

Answer 6

Merocel wrap

aluminum audio tape

Question 7

Which laser proof ETT is this?

Answer 7

LaserFlex (notice: the metal body & double cuff)

Question 8

According to Dr. Hall we would not fill the cuff of laser ETT’s with die, So what Would we use?

Answer 8

Saline

Question 9

What is the ID and the OD of the laserflex ETT

Answer 9

IV 6.0 mm

OD 8.5 mm

Question 10

Which ETT is this?

Answer 10

Rusch Merocel ETT

NOTE: it has a red rubber body and the lighter colored portion is the Merocel wrap

Question 11

What is special about the Xomed Merocel ETT

Answer 11

A double cuff that is a cuff in a cuff.

Question 12

What precautions should you take regarding the circuit during an Laser airway surgery

Answer 12

Cover circuit near patient with wet towel Wrap circuit with aluminum foil keep a backup circuit in the room

Question 13

What risk is associated with laser smoke Plume

Answer 13

Viral disease transmission (I.E. Papillomatosis with HPV DNA)

Question 14

Anesthetic agent selection for laser surgery

Answer 14

Potent short-acting drugs, such as:

Desflurane

Propofol + remifentanil

Heliox (helps Prevents heat injury sufficient)

FiO2 <0.30

succinylcholine infusion or rocuronium

Question 15

How do you protect the eyes doing laser Airway surgery

Answer 15

saline eye pads + nonflammable adhesive tape

Question 16

Standard surgical mask filtration is ____ microns

Answer 16

5

(Note: HIV, HPV, hepatitis B, hepatitis C, & TB are less than 5 microns)

Question 17

When an airway fire is detected, your first action should be… How can you get rid of O2 and the fuel source at the same time?

Answer 17

Remove the endotracheal tube

Question 18

In the event of an airway fire, if the anesthesia circuit has melted into several parts how do you provide positive pressure ventilation to the patient question?

Answer 18

Re-intubate patient (probably with a smaller diameter OETT)