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Prodigy Quick Review > Laser Surgery > Flashcards

Laser Surgery Flashcards

1
Q

What is a laser?

A

A laser is a device that amplifies a narrow, intense beam of
light. The term laser is actually an acronym that stands for Light
Amplification by Stimulated Emission of Radiation.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1036-1038.

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2
Q

How does a laser differ from ordinary light?

A

The three ways that laser light differs from that emitted from an
ordinary light are 1) it is monochromatic (a single wavelength),
coherent (it oscillates in the same phase), and collimated (it is a
narrow, parallel beam of light). Lasers can be both long (CO2
laser) and short (YAG laser) wavelengths.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 776.

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3
Q

What are the advantages of laser use in surgery over

traditional scalpels?

A

Lasers offer easier access to the surgical site, better
preservation of anatomic structures, precision, hemostasis, and
improved patient satisfaction.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1039

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4
Q

What are the three components of a laser?

A

A laser requires an energy source, an optical resonating cavity,
and a laser medium.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1038

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5
Q

What types of energy sources do lasers use and

what do they do?

A

The energy source for a laser is used to excite the atoms of the
laser medium. Energy sources include flash lamps, continuous
light sources, diodes, high-voltage discharge, and in some
circumstances, other lasers.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1038.

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6
Q

What is the laser medium?

A

The laser medium is the substance whose atoms are energized
by the energy source. It can be a solid, liquid, gas, or a
semiconductor. Most lasers are named for the medium. Gas
lasers can employ a variety of gas media including CO2, argon,
helium, and krypton. Solid-state lasers include the neodymium-
Yag laser that is commonly used in surgery. Semiconductor
lasers are typically used in electronic devices such as laser
pointers, CD players, and laser printers. Liquid lasers usually
use a complex dye immersed in a liquid such as alcohol.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1038.

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7
Q

What is the primary use of the Holmium laser?

A

The Holmium laser is often used to ablate and restructure
avascular tissues. It is commonly used in endoscopic
orthopedic procedures for bone and cartilage reshaping, stone
removal in urology, and transurethral resection of the prostate.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1040.

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8
Q

What is the medium used in an excimer laser?

A

Excimer is an abbreviated term combining the words ‘excited’
and ‘dimer’ which refers to the excitation of a noble gas such as
chlorine or fluorine and a halogen such as argon or krypton.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1041

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9
Q

What is the depth of penetration of a Nd-YAG laser

and for what procedures is it most commonly used?

A

The Nd-YAG laser penetrates to a depth of 5-7 mm and can be
used for debulking of tumors in the gastrointestinal tract, the
tracheobronchial tree, and genitourinal lesions.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1039.

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10
Q

Why is a Helium-Neon laser incorporated into a CO2

laser?

A

A CO2 laser emits infrared light, which cannot be seen by
humans. A low-energy helium-neon laser is combined with the
CO2 laser so that the operator has a visible, red light with which
the CO2 laser can be aimed.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1039.

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11
Q

What does the optical resonating cavity in a laser do?

A

The optical resonating cavity is a tubelike structure in which the
laser beam is amplified. The optical cavity contains the laser
medium. The energy source excites the electrons to a higher
energy state. Two mirrors on each end of the optical resonating
cavity reflect the laser beam back and forth through the medium
exciting the electrons of more atoms. One of the mirrors is semitransparent
and allows a part of the beam to exit the resonating
cavity as a narrow, intense beam.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1038.

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12
Q

What precautions should be taken when
anesthetizing a patient undergoing CO2 laser
vaporization of condylomatous lesions?

A

When viral tumors such as condylomatous lesions are
vaporized by laser, intact viral particles can be recovered from
the plume which warrants the use of gloves, a smoke
evacuation system, high-efficiency filter masks, and protective
goggles.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1044.

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13
Q

How does the wavelength of a laser affect the

tissues it is applied to?

A

Laser light has to be absorbed for it to be effective. If the light is
reflected or scattered, it will be ineffective. Different tissues are
affected by different laser wavelengths. The wavelength of the
laser must match the absorptive characteristic of the tissue.
Once absorbed, the laser light converts to heat within the
tissue. If the the amount of heat generated reaches 100
degrees Celsius, the tissue will be vaporized.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1038-1039.

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14
Q

What regulatory body requires a Laser Safety Officer
to be designated in facilities employing a class IIIB or
class IV laser? What are the responsibilities of the
Laser Safety Officer?

A

ANSI requires a Laser Safety Officer to be designated in all
facilities that use a class IIIB or class IV laser. This person is
responsible for overseeing the maintenance, operation, and
servicing of medical lasers used in the hospital.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1042.

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15
Q

What governmental agency regulates the
manufacturing and marketing of medical lasers?
What agency regulates medical laser safety? What
agency developed the standards for laser safety in
medical personnel?

A

The US Food and Drug Administration regulates the
manufacture and marketing of medical lasers. The American
National Standards Institute regulation Z136.1-2007 is the most
utilized standard for medical laser safety. The Occupational
Safety and Health Administration developed standards to
protect patients and health care personnel when lasers are in
use.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1042.

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16
Q

How are lasers classed by the Bureau for

Radiological Health?

A

They are classed into four categories from I to IV. Class I lasers
are incapable of producing damaging radiation and include
supermarket scanners and compact disc player lasers. Class II
lasers include laser pointers. These are visible spectrum lasers
that are not dangerous unless viewed directly for a long period
of time. Class III lasers include spectroscopy and light show
lasers and can cause eye injury if viewed directly. Class IV
lasers are hazardous and can result in fires and damage to the
skin.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1041-1042.

17
Q

What is the most common laser used in surgery?

A

The CO2 laser.
Nagelhout JJ, Zaglaniczny KL. Nurse Anesthesia. 4th ed.
Philadelphia, PA: WB Saunders Company; 2010: 1013.

18
Q

Why are CO2 lasers so dangerous?

A

Because the CO2 laser is an infrared laser, it emits essentially
as heat. A CO2 laser can melt almost any structure upon which
it is focused including steel.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1039.

19
Q

What type of laser produces the greatest amount of

toxic smoke when used?

A

The CO2 laser produces the greatest amount of smoke and
thus presents the greatest potential for spread of toxic gases
and vapors and infectious agents. Note that high-filtration
masks (0.3 micrometer) should be worn by operating room staff
when exposure to these agents is likely.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1044.

20
Q

What is the usual depth of penetration of a CO2

laser used in surgery?

A

Because the CO2 laser is greatly absorbed by water, the
vaporization of tissues usually occurs within the first 200
micrometers of tissue depth.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1039.

21
Q

For what surgeries is an excimer laser most suited?

A

Because an excimer laser has a very short wavelength and
minimal thermal effect on surrounding tissues, it is suited for
use in microsurgical procedures such as photorefractive
keratectomy and LASIK surgery.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1041.

22
Q

What safety precautions should be in place when

using a laser in an operating room?

A

Warning signs indicating that a laser is in use should be posted
both inside and outside the operating room. Windows should
be covered and all doors closed. Access to the operating room
should be limited and a safety interlock device should be
employed that shuts off the laser if the door is opened
unexpectedly. Appropriate laser protective goggles should be
worn by all personnel and eye protection should be provided to
the patient. All exposed skin should be covered. Unnecessary
shiny surfaces should be removed from the field to prevent
reflections. The surgeon should be advised to announce when
he is activating the laser. Avoid looking into the laser’s beam
and never leave a laser unattended.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1045.

23
Q

What are the major risks due to the use of a laser in

the operating room?

A

Thermal injury, eye injuries, electrical hazards, fire,
transmission of viruses, and contaminants in the smoke plume.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 79.

24
Q

Why should operating room lights be turned as bright

as possible when a laser is in use?

A

The bright light contricts the pupils and creates a smaller
aperture through which a stray laser beam could enter the eye
and damage the retina.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1043-1045.

25
Q

What does the term OD refer to when discussing

laser protective eyewear?

A

It refers to the optical density of the glass.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1044.

26
Q

What is the OD of most laser glasses used in the
operating room? What are the advantages and
disadvantages of higher OD levels?

A

The optical density of the glasses used in the operating room is
typically between 4 and 7. The higher increase in optical
density, the greater the protection from a laser beam, but the
greater difficulty in seeing through the glasses. Eyewear with
the markings OD5 or greater for 1,064 nm would be appropriate
protection for potential exposure to a Nd:YAG laser. Note:
although the lenses are often green for this type of lens, the
color cannot be relied upon as some Nd:YAG glasses are clear.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1044.

27
Q

For what type of laser would green-tinted laser

glasses protect you from?

A

Green-tinted glasses are designed to protect from Nd-YAG
lasers. There are, however, some clear laser goggles that
possess a special protective film that protects from Nd-YAG
lasers as well. In either green or clear lenses, there should be
markings indicating that the glasses are OD5 or greater for
1,064 nm, which indicates protection from the Nd-YAG laser.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1392.

28
Q

In what laser procedures should specialized masks
be employed for all personnel in the room?
Specifically, what type of masks should be used?

A

Laser vaporization of condylomatous lesions have been
demonstrated to release toxic chemicals such as benzene and
formaldehyde as well as viable viruses capable of transmitting
the disease. A high-efficiency N-95 respirator should be worn
by all personnel in the room.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 79.

29
Q

What procedures involving lasers have the highest

incidence of fire?

A

Surgical fires are most common in airway surgery (34%) and
surgery on the head or face (28%).
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1045.

30
Q

What are the appropriate precautions to take to

prevent a fire during laser surgery?

A

Appropriate precautions for fire prevention during laser airway
surgery include: reducing the FiO2 (as close to 0.21 as the
patient will tolerate), replacement of nitrous oxide with air or
helium, fill the tracheal balloon with saline that has been dyed
with methylene blue to signal cuff rupture and help dissipate
heat, limit the laser intensity and duration as much as possible,
place saline-saturated pledgets in the airway, keep a source of
water on hand in case of fire. The addition of 2% lidocaine jelly
in a 1:2 mixture with saline in the endotracheal tube cuff can
help seal small cuff leaks from laser surgery and help prevent
combustion.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 776-777.

31
Q

What are endotracheal tubes composed of and what
type of laser has the greatest capability of igniting
them?

A

Endotracheal tubes are composed of the flammable substance
polyvinyl chloride and are most susceptible to ignition by CO2
lasers.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1047.

32
Q

What are the indications that an endotracheal fire is

occurring?

A

Darkening of the endotracheal tube or circuit with soot, an
orange or red glow to the endotracheal tube, or the presence of
flames
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1047.

33
Q

What steps should be taken if an airway fire occurs?

A

Ventilation should be discontinued, the breathing circuit should
be disconnected from the patient, all gases (oxygen, nitrous,
and volatile agents) should be turned off, the endotracheal tube
removed, saline poured into the airway, and the patient
ventilated by mask with air until the fire is extinguished, at which
point, 100% O2 can be restarted.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1047.

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