Introduction

This guide provides information for clinicians for appropriate selection of airway devices for operations on the upper airway, including the larynx, in which a laser is used. It also provides information for the appropriate selection of intubation and non-intubation techniques. Tracheal tubes are commonly used in patients during general anaesthesia for such operations. These tubes provide effective control of ventilation and oxygenation, protect the airway from aspiration (if cuffed), and allow monitoring of ventilation through capnography and spirometry. A laser is a source of intense light energy which can provide an ignition source, so that a fire is a risk in the operative field. Risk of fire is particularly enhanced in oxidant (O₂ or N₂O) enriched atmospheres. Tracheal tubes assist ventilation and patient monitoring but may be ignited by the laser in these circumstances.

In these procedures, the clinician must be aware of the risk of fire. Fire requires three elements: an ignition source, a combustible material, and an oxygen source. These three are sometimes referred to as "the fire triangle". During laser surgery on the upper airway, all three elements are often present. The laser is an intense light energy which can provide a source of ignition. Tracheal tubes when present are usually made of combustible material. Finally, most patients are treated in an oxidant-enriched atmosphere. Care to minimize these three elements is essential to avoid a fire during laser surgery of the upper airway.

Of the numerous methods available for airway management during laser operations on the upper airway, each has its own risks and advantages. This guide summarizes the current methods and the applications, advantages, and disadvantages of each. The guide serves to assist the anaesthetist and surgeon in their joint decision regarding selection of the most appropriate method to oxygenate and ventilate the patient during laser surgery involving the upper airway. This guide does not recommend any one method of airway management. The test data included in Table 1 of this guide are based upon continuous beam CO₂ Lasers. While this data may not be directly applicable to other wavelengths or beam modes (such as super pulse), the basic principles still apply. Decisions regarding practice methods can only be made by the clinicians caring for the patient, having knowledge of the clinical circumstances, available expertise, and technology, e.g. the properties of the specific laser wavelength planned for the surgery.

Other complications of laser surgery not involving airway management may be found in ANSI Z136.1 (1), and ANSI Z136.3 (2), CAN/CSA Z386 M91 (3).

BS ISO TR 11991:1995

Guidance on airway management during laser surgery of upper airway

Current

Published:

15 Feb 1997