There is a need for highly trained Anesthetist who has wide experience in upper airway surgery in particular laser surgery. We have well trained anesthetists in our ENT department for LAUP and LAPT.
An intratracheal fire represents an unusual but nevertheless possible complication during laser surgery in the tracheobronchial system . The incidence of fire in the respiratory tract during laser surgery is stated as being between 0,4% and 1,5% .
How to Avoid it
• Complete wrapping of the tube in film or the use of special tubes to protect the tube in case of damage caused by laser.
• In the case of fire in the respiratory tract at least two syringes filled with sodium chloride should always be at the ready to extinguish the fire.
• The patient’s eyes should be covered by swabs soaked in sodium chloride. Oil-Water based ointments should be avoided as these could be set on fire by the laser beam
• In the event of the tube catching fire its immediate removal is necessary. It should therefore, not be unduly secured and be easily accessible for the anesthetist ..
• The reduction of the inspiratory oxygen concentration to less than 30% clearly reduces the risk of inflammation or explosion in the respiratory tract .
• The possibility of a sudden tracheotomy during intratracheal laser surgery, in case of fire.
In the case of fire, and when a total IV anesthetic was not administered, the supply of all anesthetic gases, including oxygen, should be cut off immediately and the tube disconnected. Highly dosed corticosteroids are recommended after the fire has been extinguished and 100% oxygen, given by mask, should be administered .
Dr Paulose is an ENT Consultant Plastic and Laser Surgeon with over 35 years of experience covering in Ear, Nose and Throat procedures, specializing in Laser Surgery and conventional medicine across India, U.K. and Middle East. He is currently engaged with the Jubilee Hospital, in Kerala, India.
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