1 / 12

Airway Fires

Airway Fires. A Hot Topic. Chris Bowen T? May 27 th 2011 Anesthesia Keyword Presentation. Quick Description. Reported in 0.4-1.5% of laser airway cases Believed to be grossly underreported Risk of laser contacting ET tube 1:2 Inception Direct illumination Reflected Particles

chul
Télécharger la présentation

Airway Fires

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Airway Fires A Hot Topic Chris Bowen T? May 27th 2011 Anesthesia Keyword Presentation

  2. Quick Description • Reported in 0.4-1.5% of laser airway cases • Believed to be grossly underreported • Risk of laser contacting ET tube 1:2 • Inception • Direct illumination • Reflected • Particles • 3 things every growing fire needs: • Ignition source laser, electrocautery • Oxidant O2 , Nitrous Oxide • Fuel ET tubes, drapes, etc.

  3. Potential Dangers • Seeding • Cuff puncture releases more oxidant into field • The “blowtorch” effect • Airway trauma • Smoke and debris inhalation • Death

  4. In Case of Emergency… • D/C oxygen and extubate • Douse flames with saline • Mask ventilation • Assess feasibility of reintubation for… • Bronchoscopy to assess extent of injury • Supportive care • Consider leaving tube if not burning • Admit patient to ICU

  5. An Ounce of Prevention… • OR prevention • Proper eye protection • Wet towels and minimal draping • Matte/dull finished or blackened instruments • Signs posted • Extinguisher checked and in room • Laser set on pulse not continuous • Laser set on “standby” mode

  6. …is Worth a Pound of Cure. • Anesthesia Preventions • Dentures and nasogastric tubes removed • Co-morbidities • Technique • Jet, apneic, spontaneous ventilation • Tube • Type • Metal vs. rubber vs. PVC • Coverings • Cuff preparation

  7. Tapes, Tips, and Tubes • Tapes • 3 major types • Inexpensive • Cuff filled with saline vs. air • Mini-extinguisher effect • Methylene blue dye • Tubes • Metal interlocking rings of stainless steel • Rubber soft, usually without cuff • PVC garden variety

  8. Studies • 46% prefer laser-safe ET, 26% prefer Jet Ventilation, 16% apneic, 12% spontaneous • Sosisand Dillon • Tapes • Copper demonstrated no combustion at 60 sec. • Not FDA approved • Proper application is key • Limit flexibility • Increase diameter • Can come loose • Cuffs • Saline filled cuff perforation reduced combustion by 80% • Dye allows for quick assessment of cuff integrity • Dual cuffs made extubation problematic • Tubes • Metal is resistant not impervious • increased trauma upon insertion • PVC very resistant • Taping or covering recommended • Application must be precise • Rubber most flammable* • Blood, mucus, and tissue increased combustion rates up to 60% • The YAG laser ignited all materials within 6 sec

  9. Conclusions • Metal tubing is safe and effective • Resistant not impervious • Cuffs should be filled with saline and dye • Copper tape has superior resistance when compared to other tapes and coverings • Nothing withstands the YAG

  10. Food for Thought • LMAs • Increased muscle relaxants • Are all lasers created equal? • Metallic tape vs. laser-guard coverings • FiO2 and inhaled anesthetic levels • Tracheostomy

  11. Thank You Questions?

  12. Sources • Wu CC, Shen CH, Ho WM. Endotracheal tube fire induced by electrocautery during tracheostomy--a case report. Acta Anaesthesiol Sin. 2002 Dec;40(4):209-13. PubMed PMID: 12596621. • Mattucci KF, Militana CJ. The prevention of fire during oropharyngeal electrosurgery. Ear Nose Throat J. 2003 Feb;82(2):107-9. PubMed PMID: 12619467. • García-Sánchez MJ, Pérez-Rodríguez JF, Herrero-Manzano R. [Endotracheal tube fire during laryngeal surgery: analysis of the root cause of a sentinel event]. Rev Esp Anestesiol Reanim. 2010 Mar;57(3):173-6. Spanish. PubMed PMID: 20422850. • Awan MS, Ahmed I. Endotracheal tube fire during tracheostomy: a case report. Ear Nose Throat J. 2002 Feb;81(2):90-2. Review. PubMed PMID: 11868480. • Rinder CS. Fire safety in the operating room. Curr Opin Anaesthesiol. 2008 Dec;21(6):790-5. Review. PubMed PMID: 18997531. • Roy S, Smith LP. What does it take to start an oropharyngeal fire? Oxygen requirements to start fires in the operating room. Int J Pediatr Otorhinolaryngol. 2011 Feb;75(2):227-30. Epub 2010 Dec 10. PubMed PMID: 21145598. • Carin A. Hagberg, MD, Benumof's Airway Management (Second Edition) Principles and practice 2007 Mosby, Inc. pg. 901, 906-938, 1197-98. • John L. Atlee MD., Complications in Anesthesia 2nd Ed. 2006 Saunders. Pg. 750

More Related