Airway Laser Surgery
Content
Airway laser surgery:
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Risk for both the patient and OR personal Knew what is the indication→ papiloma, stenosis, neoplasm → PFT, flow volume loop, CT The airway is shared with the surgeon→ close communication Eyeglasses and laser mask, Pt eyes closed, covered with wet gauzes, and metal shields, cover the exposed skin with wet towels Consider glyco pre-med Use laser-metal ETT, and fill the cuff with NS with methylene blue Avoid N2O, use the lowest FiO2 possible < 40%, other Jet ventilation Pt need to be completely paralyzed In case of airway fire→ remove ETT, have 60 cc syringe filled with NS ready, after controlling the fire asses the airway damage, and ongoing fire, avoid high Fi02 initially till you make sure that there is no ongoing fire→ direct laryngoscope, bronchoscope with possible lavage and CXR, reintubate with new ETT, keep intubated, Abx, and steroids →ICU post-op CO2 laser only 0.01 mm penetration less bleeding and edema post-op With Nd-YAG laser deeper penetration, and risk of air embolism
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The metal-ETT are bigger than the PVC tubes so use one size smaller
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Risk for both the patient and OR personal Knew what is the indication→ papiloma, stenosis, neoplasm → PFT, flow volume loop, CT The airway is shared with the surgeon→ close communication Eyeglasses and laser mask, Pt eyes closed, covered with wet gauzes, and metal shields, cover the exposed skin with wet towels Consider glyco pre-med Use laser-metal ETT, and fill the cuff with NS with methylene blue Avoid N2O, use the lowest FiO2 possible < 40%, other Jet ventilation Pt need to be completely paralyzed In case of airway fire→ remove ETT, have 60 cc syringe filled with NS ready, after controlling the fire asses the airway damage, and ongoing fire, avoid high Fi02 initially till you make sure that there is no ongoing fire→ direct laryngoscope, bronchoscope with possible lavage and CXR, reintubate with new ETT, keep intubated, Abx, and steroids →ICU post-op CO2 laser only 0.01 mm penetration less bleeding and edema post-op With Nd-YAG laser deeper penetration, and risk of air embolism
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The metal-ETT are bigger than the PVC tubes so use one size smaller
