Lasers

Question 1

Laser stands for _____?

Answer 1

Light Amplification by Stimulated Emission of Radiation

Question 2

What is the relationship of wavelength to power?

Answer 2

Shorter the wavelength, higher the frequency, higher the power.

Question 3

Name 2 ‘weak’ medical lasers and their uses

Answer 3

CO₂ - Upper airway

Nd:YAG - distal tracheobronchial tree and retina

Note: The slides do say that Nd:YAG is a “powerful” laser, but my justification here is that while it is approximately 10X more powerful than the CO₂, when compared to the other lasers (KTP, Argon) on the chart 3 slides prior, the Nd:YAG is a RELATIVELY lower-power laser.

Question 4

Name 2 ‘powerful’ medical lasers and their uses.

Answer 4

KTP - Neurosurgical and otolaryngeal

Argon - Neuro, retinal, otolaryngeal

Question 5

What is the color of a CO₂ laser, Nd-YAG laser, He-Ne laser. Are they visible?

Answer 5

CO₂: Invisible (far infrared)
Nd-YAG: Not visible (Near infrared)
He-Ne: Red (used as aiming beam)

The first 2 are not visible to the naked human eye; the 3rd is.

Question 6

Name 3 main risks associated with laser use.

Answer 6

I got 4!

Fire
Burns
Eye Damage
Loss of Airway

Question 7

Laser may be used for what type of surgeries of particular involvement with anesthesia providers?

Answer 7

Airway surgeries:

• laryngeal papillomas
• tracheal scarring
• vascular malformations
• neoplasms
• idiopathic subglottic stenosis

Question 8

What type of anesthesia is recommended for laser airway surgery?

Answer 8

• VAA (Sevo) or TIVA
• Low FiO2 (40% or less, 21% preferred)
• Complete neuromuscular blockade
• Avoid N₂O

Question 9

What is the preparation for a laser airway case?

Answer 9

• Anti-sialagogue
• Eye protection for OR personnel AND patient
• Laser tube or ETT wrapped with laser tape (smaller tube size)
• Bottle of saline/water immediately available

Question 10

What is the maintenance technique of an above case? (this one’s a little long, sorry, it’s all the crap that was in the slide…)

Answer 10

• Complete neuromuscular blockade
• Routine monitoring
• Close monitoring of breath sounds and EtCO₂
• Do not look into laser
• Do not allow laser to lay on drapes
• Be aware of when laser is in use and confirm in standby mode
• Eye Protection (lube pt eyes, tape shut; saline soaked eye pads; laser goggles on pt; appropriate laser glasses on all OR personnel)
• Continually assess cuff integrity
• Do not breathe laser plume

Question 11

How do you treat an airway fire?

Answer 11

• Stop ALL gas flow, CUT pilot tube, EXTUBATE
• Extinguish with H2O or NS
• RE-INTUBATE emergently and VENTILATE with AIR ONLY until confirmation of no remaining fire
• THEN VENTILATE with 100% O’s
• Assess larynx, trachea, bronchiole tree for damage

Question 12

What is the emergence, extubation technique?

Answer 12

• Deep extubation
• Airway blood may remain despite suctioning
• Ensure all pledgets or throat packs have been removed

Question 13

What are the postop risks?

Answer 13

• Laryngospasm d/t irritation or remaining blood
• Stridor
• Excessive coughing
• Bronchospasm

INTERVENE QUICKLY!!!

Question 14

What 3 things are needed for a fire?

Answer 14

• Fuel
• Oxidizer
• Ignition source

Question 15

Most common laryngospasm muscle?

Answer 15

Cricothyroid (lengthens and tenses cords)