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Anesthesia in Laser Surgery

Anesthesia in Laser Surgery. R1 Minghui Hung Department of Anesthesiology, NTUH. “Never are cooperation and communication between surgeon and anesthesiologist more important than during head and neck surgery.” Morgan, Clinical Anesthesiology. Physics of Laser light (I).

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Anesthesia in Laser Surgery

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    1. Anesthesia in Laser Surgery R1 Minghui Hung Department of Anesthesiology, NTUH

    2.

    3.

    4. Physics of Laser light (I)

    5. Physics of Laser light (II)

    6. Laser system components

    7. Laser system components Light guide

    8. Used as scalpels and electrocoagulators Dermatology, thoracic surgery, ophthalmology, gynaecology, plastics, ENT, urology and neurosurgery

    9. Laser interaction with tissue

    10. Common used Laser lights

    11. Atmospheric contamination Perforation of a vessels or structure Embolism Inappropriate energy transfer

    12. Plume of smoke and fine particulates (mean size 0.31um) Efficiently transported and deposited in the alveoli Sensitive individuals: headaches, tearing, and nausea after inhalation Animal study: interstitial pneumonia, bronchiolitis, reduced mucociliary clearance, inflammation, emphysema Prevention ? smoke evacuator ? high-efficiency masks

    13. Misdirected laser energy may perforate a viscus or a large blood vessel Laser-induced pneumothorax Perforation may occur several days later when edema and necrosis are maximal

    14. Venous gas embolism when laparoscopic or hysteroscopic laser surgery At hysteroscopy, liquid (saline) coolant is the only safe option If coolant gas must be used, CO2 should be considered ? Continuous airway CO2 monitoring

    15. Incidentally pressing the laser control trigger Tissue damage outside of surgical site Drape fire Eye (patient or other medical staff) Endotracheal tube fires

    16. Incidence: 0.5 1.5 % Source: direct laser illumination reflected laser light incandescent particles of tissue blown from the surgical site

    17.

    18. Reduce the flammability of the endotracheal tube Use Venturi ventilation Use intermittent apnea technique

    19.

    20. wrapping with moistened muslin coating with dental acrylic wrapping with metallized foil tape ? most popular approach aluminum foil copper foil plastic tape thinly coated with metal

    22. No cuff protection Adds thickness to tube Not an FDA-approved device Protection varies with type of metal foil Adhesive backing may ignite May reflect laser onto non-targeted tissue Rough edges may damage mucosal surfacess

    23. Oxygen and nitrous oxide are powerful oxidizers Reduce FiO2 to minimum concentration Helium may benefit as a diluent gas Volatile anesthetics currently used are nonflammable and nonexplosive Pyrolized toxic compounds

    24. Norton. spiral wound stainless steel ETT Bivona Fome-Cuff. aluminium spiral tube with a silicone polyurethane foam cuff Xomed Laser-Shield. silicone elastomer tube containing metallic powder Mallinckrodt Laser-Flex. airtight stainless steel spiral wound tube with two PVC cuffs

    25. Barotrauma Pneumothorax Restriction to only intravenous agents Gastric distention Relative requirement for compliant lungs

    26. Remove source of fire (the laser!). Stop ventilating, disconnect circuit, extubate. Extinguish fire in bucket of water (MUST have one ready!). Mask ventilate with 100% O2, continue anaesthesia i.v. Direct laryngoscopy & rigid bronchoscopy for damage and debris.

    27. Reintubate if damage. Blowtorch fire may need distal fibreoptic bronchoscopy and lavage. Severe damage may need low tracheostomy. Assess oropharynx and face. CXR. Steroids.

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