Laser ppt Flashcards
Josh's guide to lasers
What does LASER stand for
Light Amplification by Stimulated Emission of Radiation
what is a device that controls the way energized atoms release photons
Laser
what are the 3 main properties of a laser that make if very different from other lights
monochromatic
coherent
directional
what property of a laser is that it contains one specific wavelength of light (one specific color).
monochromatic
the wavelength of light is determined by what?
the amount of energy released when the electron drops to a lower orbit
what property of a laser describes how it is organized- thus each photon moves in step with the others, this means that all the photons have wave fronts that launch in univision
coherent
which laser property is that a laser light has a very tight beam and is very strong and concentrated
directional
a flashlight in contrast releases light in many directions, the light is very weak and diffuse
Carbon dioxide laser properties (2)
invisible
marked with a helium-neon aiming beam
what is the Carbon dioxide laser used for
upper airway sx
is carbon dioxide laser common
yes,
very common
Nd-YAG laser stand for what?
neodymium-yttrium aluminum-garnet laser
Nd-YAG laser properties (1)
short wave length allows transmission by fiberoptics
Nd-YAG laser is used for what sx’s
distal tracheobronchial tree and retina sx
KTP laser stand for what?
Potassium-titanylphosphate laser
KTP laser can be transmited by what?
fiberoptics
KTP laser is used in what sx’s
neurosurgical and
otolarygeal
Argon Laser can be transmitted by what
fiberoptics
Argon laser is used in what sx’s
neurological, retinal, and otolaryngological
7 wavelengths in order of power (weakest to most powerful
radio microwave infrared visible ultraviolet x-ray gamma ray
with laser wavelengths longer wavelengths= what?
lower freq and lower energy
all start with L
with laser wavelengths shorter wavelengths= what?
higher freq and higher energy
for jake sHorter= Higher and Higher) :
frequancy is inversly proprtional to what??
wavelength
the higher the frequency the smaller the wavelength
what has a higher freguency?
KTP Wave length is 532
or
Nd:YAG wave length 1064
KTP
remember
freq is inversly proportional to wave length
the longer the wavelength the lower freq
which laser is for deep tissue? and why?
Nd-YAG
b/c of near infrared I guess????
what is the only laser that wet tissue can protect pt (like a wet towel)
CO2 laser
what 2 lasers are absorbed by Hgb and melanin or other similar pigments? transmitted through clear substances.
tissue penetration 0.5-2 mm
Argon
KTP
which laser is more readily absorbed by dark tissue?
transmitted through clear fluids
tissue penetration 2-6 mm
Nd-YAG
which laser is strongly absorbed by water, and thus by all tissue, pigmented or not. tissue penetration <0.5mm
CO2
the greater the wavelength = the _______ absorption by water
greater
CO2 greatest WL 10,600
CO2 laser properties?
WL 10,600
Longer WL= Low freq= Low energy
Nd-YAG laser properties
WL 2064
sHorter WL= Higher freq= Higher energy
Lasers are freq used in airways for what sx’s
laryngel papillomas tracheal scaring vascular malformations neoplasms idiopathic subglottic stnosis
Risk of lasers in sx
loss of AIRWAY
FIRE
burns
eye damage
Preoperative preperation for laser sx
antisialagogue
Eye protection for personnel and pt
Laser tube or ETT wrapped with laser tape
Airway concerns with laser
shared airway airway obstruction (foreign body, edema, obstructive mass/lesion)
Induction concerns?
airway patency RSI vs smooth IV or mask OSA (must preoxygenate (may need oral airway)) (sevo least irritating to airway)
OSA is who princilple
burnelli’s (spelling???)
thats why we give CPAP they lost pressure
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)
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
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)
how do you prevent inhalation injury? (to yourself and pt)
continually assess integrity of cuff
don’t breath laser olume
when doing airway sx with a laser what do you want to do with FiO2?
40% or less (preferable 21%)
When doing airway sx with a laser what VAA do you want to avoid? and why?
N2O
supports combustion
when doing airway sx with a laser what must you always have immediately available?
bottle of saline or water
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
can you wrap a ETT in laser foil to protect from laser
yep
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
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
what 3 things are needed for a fire
oxidizer (N2O or O2)
fuel (drapes or ETT)
Ignition source (laser or Bovie)
what meds do you want to give post airway fire?
corticosteroids
Antibiotics
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
Postop risk of laser sx in airway
laryngospasms (due to irritation and remaining blood)
-stridor, coughing, bronchospasm
A laryngospasm is caused by what?
vocal cord irritation
what is the primary muscle responsible to laryngospasms
cricothyroid
Treatment of laryngospasms
- CPAP by mask (attempt positive pressure ventilation <20cm H2O
- jaw thrust (at angle of Ramus-accupressure point)
- Succinylcholine if needed
