Preventing laser-induced fires

·       All towels, gauze sponges, cottonoids, clothing should be removed or continuously moistened throughout procedure

·       Hair in or adjacent to laser fields should be shaved or continuously moistened with saline or water

·       Clear facemasks, nasal cannulae and other plastic airway devices should be used instead of colored devices

·       Patient’s skin should not be cleaned with alcohol-based solutions; patient should not use hairspray or other alcohol-containing personal care products before procedures

·       Anesthesia:

-        Inspired gas mixture should contain minimal oxygen to maintain patient’s oxygen saturation, and gases (e.g., helium, nitrogen, compressed air) and inhaled anesthetics with less combustility

-        Oxygen and other gases (e.g., nitrous oxide) should never be directed toward the laser field

-        Laser procedures near the airway should ideally involve intravenous sedation and local nerve blocks; if general anesthesia with endotracheal intubation is absolutely required, endotracheal tube shafts should be made from a metal, laser-safe material or wrapped with aluminum or copper foil tape in a spiral manner, so that flexion of the tube does not expose bare areas to the laser; endotracheal cuffs should be filled with saline rather than air

-        Larygeal mask airways with spontaneous respirations are preferred over face masks due to less oxygen leakage; if a face mask is used, an oxygen analyzer may be used to ensure minimal leakage

-        Fluorocarbon cryogens are non-flammable, although ethyl chloride has been reported to ignite after contact with laser pulses

Handling laser-induced fires

·       A plan of action should be rehearsed by all operative personnel in case of a fire

·       A contain of water or saline and a fire extinguisher should be available close to operative field

·       Ventilation should be stopped and gases disconnected; endotracheal tube, mask, laryngeal mask airway, nasal cannula should be removed

·       Physicians should be aware that required protective eyewear make it harder to see onset of fire and smoke, and employ extra caution

·       Icepacks should be applied to patient skin after fire has been extinguished to minimize thermal injury

·       A flexible nasal pharyngoscope or bronchoscope can be used to survey the upper airway and laryngeal tissues for injury

·       Abundant water irrigation and povidone-iodine soap can be used to remove carbonized debris from burned areas

·       Bacitracin ointment should be applied to skin burns