Airway fires in the surgical suite are catastrophic and deadly. When there is a combination of an endotracheal (ET) tube filled with oxygen and an ignition source such as a laser, the standard ET tube acts like a blowtorch in the patient’s trachea. These tubes can be ignited at oxygen levels as low as 26% [1]. Laser safety programs should incorporate measures to isolate the triad that is present in all Operating Room (OR) fires: a source of oxygen, fuel, and ignition. Although safety hazards are inherent when lasers are used in the OR, they can be significantly reduced, if not eliminated, if proper procedures are implemented and adhered to whenever a laser is utilized in the OR. This article reviews the safety hazards and the implementation of a “Laser Time Out” to allow for the safe use of lasers in the Operating Room.

1.
Wolf
,
G.L.
, &
Simpson
,
J. L.
(
1987
)
Flammability of endotracheal tubes and nitrous oxide enriched atmosphere
.
Anaesthesiology
67
,
236
241
.
2.
McLeskey
,
C. H.
(
1989
)
Anaesthetic management of patients undergoing endoscopic laser surgery
.
Anaesthesiology Clinics of North America
7
,
611
629
.
3.
Bruley
,
M. E.
(
2004
)
Surgical fires; perioperative communication is essential to prevent this rare but devastating complication
,
13
,
467
471
.
4.
Chhetri
,
D. K.
,
Long
,
J. L.
(
2011
)
Airway management and CO2 laser treatment of subglottic and tracheal stenosis using flexible bronchoscope and laryngeal mask anaesthesia
.
Operative Techniques in Otolaryngology
,
22
,
131
134
.
5.
American Society of Anaesthesiologists
(
2008
)
Practice advisory for the prevention and management of operating room fires
.
Anaesthesiology
,
108
,
786
801
.
6.
Kinder
,
C. S.
(
2008
)
Fire safety in the operating room
.
Current Opinion in Anaesthesiology
,
21
,
790
795
.
7.
Yardley
,
I. E.
,
Donaldson
,
L. J.
(
2010
)
Surgical fires, a clear and present danger
.
The Surgeon
,
8
,
87
92
.
8.
Sheinbein
,
D. S.
,
Loeb
,
R. G.
(
2010
)
Laser surgery and fire hazards in ear, nose, and throat surgeries
.
Anaesthesiology Clin
,
28
,
485
496
.
9.
Weinbaum
,
A.
,
Hathcock
,
G.
,
Whalen
,
J.
, &
Wolborsht
,
M.
(
1998
)
Here’s how to prevent lasers fires in the OR
,
Health Facilities Management
11
(
9
),
28
.
10.
Lai
,
H. C.
,
Juang
,
S. E.
,
Lui
,
T. J.
, &
Ho
,
W. M.
(
2002
)
Fires of endotracheal tubes of three different materials during carbon dioxide laser surgery
,
ACTA Anaesthesiol Sin
,
40
,
47
51
.
11.
Komatsu
,
T.
,
Kaji
,
R.
,
Okazaki
,
S.
,
Miyawaki
,
I.
,
Ishihara
,
K.
, &
Takahashi
,
Y.
(
2008
)
Endotracheal tube ignition during endotracheal laser treatment
,
Asian Cardiovase. Thorase. Ann.
,
16
,
e49
51
.
12.
Handa
,
K. K.
,
Bhalla
,
A. P. S.
, &
Arora
,
A.
(
2001
)
Fire during use of Nd-Yag laser
.
International Journal of Pediatric Otorhinolaryngology
,
60
,
239
242
.
13.
Santos
,
P.
,
Ayuso
,
A.
,
Luis
,
M.
,
Martinez
,
G.
, &
Sala
,
X.
(
2000
)
Airway ignition during C02 laser laryngeal surgery and high frequency jet ventilation
,
European Journal of Anaesthesiology
,
17
,
204
207
.
14.
Wang
,
H. M.
,
Lee
,
K. W.
,
Tsai
,
C. J.
,
Lu
,
I. C.
, &
Kuo
,
W. R.
(
2006
)
Tracheostomy tube ignition during microlaryngeal surgery using diode laser: a case report
,
Kaohsiung J. Med. Sci.
,
22
,
199
201
.
15.
Raman
,
V.
,
Tobias
,
J. D.
,
Bryant
,
J.
,
Rice
,
J.
,
Jatana
,
K.
,
Merz
,
M.
,
Elmaraghy
,
C.
, &
Kang
,
D. R.
(
2012
)
Effect of culfed and uncuffed endotracheal tubes on the oropharyngeal oxygen and volatile anaesthetic agent concentration in children
,
International Journal of Pediatric Otorhinolaryngology
,
76
,
842
844
.
16.
Dhar
,
P.
, &
Malik
,
A.
(
2011
)
Anaesthesia for laser surgery in ENT and the various ventilatory techniques
.
Trends in Anaesthesia and Critical Care
,
1
,
60
66
.
17.
Smith
,
L. P.
, &
Roy
,
S.
(
2011
)
Operating room fires in otolaryngology: risk factors and prevention
,
American Journal of Otolaryngology-Head and Neck Medicine and Surgery
,
32
,
109
114
.
18.
Werkhaven
,
J.
(
2004
)
Microlaryngoscopy – airway management with anaesthetic techniques for C02 laser
.
Pediatric Anaesthesia
,
14
,
90
94
.
19.
Kuo
,
C. H.
,
Tan
,
P. H.
,
Chen
,
J. J.
,
Peng
,
C. H.
,
Lee
,
C. C.
,
Chung
,
H. C.
, &
Tseng
,
C. K.
(
2001
)
Endotracheal tube fires during carbon dioxide laser surgery on the larynx – a case report
,
ACTA Anaesthesia Sin.
,
39
,
53
56
.
20.
Recommended Practices
(
2012
)
Implementing AORN recommended practices for laser safety
,
AORN J.
,
95
(
5
),
613
627
.
21.
Laser Institute of America
, http://lia.org/. Accessed November 23, 2012
22.
Recommended Practices
(
2012
) Recommended practices for laser safety in perioperative practice settings,
Perioperative Standards and Practices
.
Denver, CO
,
AORN, Inc.
,
125
142
.
This content is only available via PDF.
You do not currently have access to this content.