Airway fires: Concerns, causes, case histories and prevention

The author previously presented details of two laser-induced airway fire cases for which he served as an expert witness, the first at ILSC 2003 and the second at ILSC 2007. The outcome of the first reported case was and continues to be tragic in that the patient, 11 years old at the time of the accident, is permanently eating and breathing through plastic tubes. The outcome of the second case, while not as tragic, resulted in a permanent tracheotomy with its associated problems of periodic tube replacement and airway debridement, speaking with difficulty, and problems being in public due to frequent significant choking and coughing. The objectives of this paper are four-fold; 1) to review the flammability (ignition) triad components that may be in the airway during laser surgery, 2) to compare the actions of the physicians involved in these cases with the expected (required) standard of care, 3) to present the lessons learned from these cases and the dos and don’ts which if followed should prevent airway fires, and 4) to present a check list which if followed should prevent laser-induced airway fires.