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Airway Fires

Airway Fires. A Hot Topic. Chris Bowen T? May 27 th 2011 Anesthesia Keyword Presentation. Quick Description. Reported in 0.4-1.5% of laser airway cases Believed to be grossly underreported Risk of laser contacting ET tube 1:2 Inception Direct illumination Reflected Particles

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Airway Fires

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  1. Airway Fires A Hot Topic Chris Bowen T? May 27th 2011 Anesthesia Keyword Presentation

  2. Quick Description • Reported in 0.4-1.5% of laser airway cases • Believed to be grossly underreported • Risk of laser contacting ET tube 1:2 • Inception • Direct illumination • Reflected • Particles • 3 things every growing fire needs: • Ignition source laser, electrocautery • Oxidant O2 , Nitrous Oxide • Fuel ET tubes, drapes, etc.

  3. Potential Dangers • Seeding • Cuff puncture releases more oxidant into field • The “blowtorch” effect • Airway trauma • Smoke and debris inhalation • Death

  4. In Case of Emergency… • D/C oxygen and extubate • Douse flames with saline • Mask ventilation • Assess feasibility of reintubation for… • Bronchoscopy to assess extent of injury • Supportive care • Consider leaving tube if not burning • Admit patient to ICU

  5. An Ounce of Prevention… • OR prevention • Proper eye protection • Wet towels and minimal draping • Matte/dull finished or blackened instruments • Signs posted • Extinguisher checked and in room • Laser set on pulse not continuous • Laser set on “standby” mode

  6. …is Worth a Pound of Cure. • Anesthesia Preventions • Dentures and nasogastric tubes removed • Co-morbidities • Technique • Jet, apneic, spontaneous ventilation • Tube • Type • Metal vs. rubber vs. PVC • Coverings • Cuff preparation

  7. Tapes, Tips, and Tubes • Tapes • 3 major types • Inexpensive • Cuff filled with saline vs. air • Mini-extinguisher effect • Methylene blue dye • Tubes • Metal interlocking rings of stainless steel • Rubber soft, usually without cuff • PVC garden variety

  8. Studies • 46% prefer laser-safe ET, 26% prefer Jet Ventilation, 16% apneic, 12% spontaneous • Sosisand Dillon • Tapes • Copper demonstrated no combustion at 60 sec. • Not FDA approved • Proper application is key • Limit flexibility • Increase diameter • Can come loose • Cuffs • Saline filled cuff perforation reduced combustion by 80% • Dye allows for quick assessment of cuff integrity • Dual cuffs made extubation problematic • Tubes • Metal is resistant not impervious • increased trauma upon insertion • PVC very resistant • Taping or covering recommended • Application must be precise • Rubber most flammable* • Blood, mucus, and tissue increased combustion rates up to 60% • The YAG laser ignited all materials within 6 sec

  9. Conclusions • Metal tubing is safe and effective • Resistant not impervious • Cuffs should be filled with saline and dye • Copper tape has superior resistance when compared to other tapes and coverings • Nothing withstands the YAG

  10. Food for Thought • LMAs • Increased muscle relaxants • Are all lasers created equal? • Metallic tape vs. laser-guard coverings • FiO2 and inhaled anesthetic levels • Tracheostomy

  11. Thank You Questions?

  12. Sources • Wu CC, Shen CH, Ho WM. Endotracheal tube fire induced by electrocautery during tracheostomy--a case report. Acta Anaesthesiol Sin. 2002 Dec;40(4):209-13. PubMed PMID: 12596621. • Mattucci KF, Militana CJ. The prevention of fire during oropharyngeal electrosurgery. Ear Nose Throat J. 2003 Feb;82(2):107-9. PubMed PMID: 12619467. • García-Sánchez MJ, Pérez-Rodríguez JF, Herrero-Manzano R. [Endotracheal tube fire during laryngeal surgery: analysis of the root cause of a sentinel event]. Rev Esp Anestesiol Reanim. 2010 Mar;57(3):173-6. Spanish. PubMed PMID: 20422850. • Awan MS, Ahmed I. Endotracheal tube fire during tracheostomy: a case report. Ear Nose Throat J. 2002 Feb;81(2):90-2. Review. PubMed PMID: 11868480. • Rinder CS. Fire safety in the operating room. Curr Opin Anaesthesiol. 2008 Dec;21(6):790-5. Review. PubMed PMID: 18997531. • Roy S, Smith LP. What does it take to start an oropharyngeal fire? Oxygen requirements to start fires in the operating room. Int J Pediatr Otorhinolaryngol. 2011 Feb;75(2):227-30. Epub 2010 Dec 10. PubMed PMID: 21145598. • Carin A. Hagberg, MD, Benumof's Airway Management (Second Edition) Principles and practice 2007 Mosby, Inc. pg. 901, 906-938, 1197-98. • John L. Atlee MD., Complications in Anesthesia 2nd Ed. 2006 Saunders. Pg. 750

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