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

 

Management:

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

 

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