Anesthesia and laser surgery of the laryngo-nasal-ear region
Heine, P.; Axhausen, M.
Der Anaesthesist 37(1): 10-18
1988
ISSN/ISBN: 0003-2417 PMID: 3281506 Document Number: 309363
The applications of lasers in surgery is nowadays a widely used and well appreciated technique. Besides convincing advantages (precision in surgical manipulations, excellent hemostasis, minimal postoperative swelling, rapid healing) laser-unique hazards require particular safety considerations to avoid accidental injuries to patients and medical personnel. For damage of the eyes is the greatest risk in laser surgery goggles designed to the respective wavelength of the specific laser must be worn by everyone in the operation theatre. The patient's eyes are best protected by covering them with water moistened gauze pads. To avoid reflection of the laser beam only instruments with dull surfaces should be used. The proper function of the laser itself has been tested by a well trained surgeon before operation. Especially in microlaryngeal surgery carried out under general anaesthesia, severe complications, e.g. pneumothorax, penetration of large vessels or destruction of the surrounding tissues, may be the result of beam reflection or unskilled use. However, the most serious hazard for the patient-and even that one with the highest incidence (0.4 to 1.5%)-arises from the close neighbourhood of endotracheal tube and laser beam while operating in the larynx or the upper airways. In tests it has been demonstrated that the beams of different lasers penetrate tubes of various materials (silicone, semi- or transparent pvc) to a different extent, often igniting the material. High oxygen and nitrous oxide contents support tube ignition. The inhalation of smoke and toxic pyrolysis products either of tube-material or, possibly, of volatile anaesthetics are followed by serious damage of trachea and lung tissue.