Laser ENT surgery

Prevention:

Theatre

· Laser safety person

· Windows covered

· Warning signs

· Goggles

· Water bucket

(Also education and training)

Surgical team

· Minimum power, minimum size, minimum duration

· Non-reflective instruments (matte, ebonized)

· Flame-resistant drapes

Anaesthetic team

· Gas: FiO₂ <0.3, avoid N₂O

· Tube: laser-resistant ETT / room air jet / room air HFNP

· Cuff: distal with air, proximal with saline or methylene blue

· Eyes: lubricated and covered

Put the fire out

Surgeon:

· Stop laser

· Flood with water

Anaesthetist:

· Remove ETT

· Mask ventilate

· Start IV anaesthesia

Assess damage

· Larynx: laryngoscopy

· Airways: bronchoscopy

· Lungs: CXR

Post-op care

· Critical incident

· ? Steroids

· ? ICU

· ? Re-intubate

· ? Tracheostomy