Anesthesia for Laser Surgery - anaesthesiacoin激光手术的麻醉anaesthesiacoin.pptVIP

Laser airway surgery Disadvantages Unable to monitor pCO2 Contamination of lower resp. tract Intermittent endotracheal intubation Airway Fire Combustion Flammable substrate Oxidant Speed of combustion Incidence - 0.5 – 1.5% Airway Fire Prevention Non flammable substrate / jet ventilation Reducing O2 (30%) Avoid N2O Helium (high thermal conductivity) Avoid Flash point(below critical temp.) Airway Fire Management of an airway fire: Plan ahead, review plan with team. Immediately stop ventilation. Disconnect circuit (blow torch effect with flaming ETT and 02 flow). Remove and extinguished flaming ETT in a bucket of water. Extinguish any flaming debris in pharynx with water or saline. Reintubate, ventilate with 100% O2,? flush pharynx with cold water. Flexible and rigid? bronchoscopy to assess damage and remove debris. consider steroids,? humidified gases, and prolonged ventilation in ICU. Consider tracheostomy if severe lower airway burn. Monitor CXR, ECG, and ABGs. Anesthetic considerations surgical procedure Patient’s pre-existing conditions Hazards of laser surgery to the patient, OR personnel and equipment Anesthesiologist must be aware of Laser medium Physical properties Vital structures around the point of focus Iceberg effect Anesthetic plan Preoperative evaluation of the airway (stridor, voice quality, ventilation pattern, flow volume loops, CT, MRI, or fiberoptic airway evaluation) Mutual planning with the surgeon. Aspiration prophylaxis Total iv anesthesia (propofol, remifentanil, short acting relaxant) Xylocaine spray Tooth guard. Methylene blue in ETT cuff. Saline gauze protection of face and airway and keep mucosal surfaces moist Laser should be used in short repeated bursts (pulse), rather than in a prolonged continuous mode. Communicate and monitor video camera for signs of airway fire. O2 30% using an air-oxygen mixture, avoid N2O and volatile anesthetic agents. Transcutaneous CO2 monitoring if available may be helpful. Esmolol and NTG immedi