Lasers

Question 1

What is a laser?And what does the Acronym mean?

Answer 1

a device that controls the way that energized atoms release photons.
Light Amplification by Stimulated Emission of Radiation

Question 2

What does monochromatic mean?

Answer 2

it contains one specific wavelength of light.

Question 3

What does coherent mean?

Answer 3

it is organized

Question 4

What is directional?

Answer 4

a laser light that has a very tight beam and is strong and concentrated

Question 5

Carbon Dioxide lasers

Answer 5

invisible laser (marked with helium-neon aiming beam) Widely used for upper airway surgery. Low energy (infra red). Penetrates <0.5cm tissue penetration

Question 6

NdYAG laser

Answer 6

short wavelength allows transmission by fiber optics. Used on distal tracheobronchial tree and retina surgery. low energy (near infrared) 2-6mm tissue penetration. Coagulates and necrosis of deeper tissues

Question 7

KTP laser

Answer 7

can be transmitted by fiber optics. Used in neurosurgical and otolaryngeal surgeries high energy (green) 0.5-2mm tissue penetration

Question 8

Argon laser

Answer 8

can be transmitted by fiberoptics. Useful in neurological, retinal and otolaryngeal procedures high energy (blue/green) 0.5-2mm tissue penetration

Question 9

How does length and frequency effect energy?

Answer 9

long wavelength and low frequency have LOW energy

Question 10

is co2 a strong or weak laser?

Answer 10

weak

Question 11

how should you protect a patient from co2 laser?

Answer 11

water soaked towels

Question 12

Laser surgeries of the airway

Answer 12

laryngeal papillomas, tracheal scring, vascular malformations, neoplasms, idiopathic subglottic stenosis

Question 13

Risks of laser surgeries

Answer 13

Loss of airway, fire, burns, eye damage

Question 14

Preop prep for laser sx

Answer 14

antisaligogue, eye protection for personell and patients, laser tube or ETT wrapped with laser tape

Question 15

Airway concerns

Answer 15

shared airway, foreign body, airway edema, obstructive mass/ lesion

Question 16

Concerns for induction

Answer 16

RSI vs smooth IV vs mask induction, use sevo, OSA concerns

Question 17

Airway narrowing for OSA because of what effect?

Answer 17

bernoulli’s

Question 18

Maintenance during surgery

Answer 18

Prevent loss of airway, keep in close communication with surgeon, closely monitor breath sounds and EtCO2, prevent burn injury, be aware when laser is in use, do not lay laser on drapes,

Question 19

Eye protection?

Answer 19

lube pt’s eyes, tape em shut, saline soaked eye pads, laser goggles

Question 20

How do you prevent inhalation injury?

Answer 20

continually assess integrity of cuff, do NOT breath laser plume

Question 21

What should you keep your FiO2 at?

Answer 21

.40 or less, .21 is preferable

Question 22

important things to remember during maintenance

Answer 22

avoid N2O, complete nueromuscular blockade, routine monitoring (precordial), bottle of saline or water immediately available.

Question 23

What is a common size for a laser tube?

Answer 23

5.5 - 6.5

Question 24

In case of fire…..

Answer 24

be prepared to extinguish and treat, be prepared to emergently extubate patient in case of airway fire. Stop all gas flow, extinguish, reintubate and vent with AIR ONLY until all fire extinguished, switch to 100% O2, assess airway for damamge

Question 25

Post airway fire how do you treat?

Answer 25

corticosteroids, antibiotics, and continued ventilation

Question 26

Extubation

Answer 26

surgeon may request deep extubation but airway blood may remain despite suctioning and cause laryngospasm.