Term
True or false: Patient movement is not a big deal with laser surgery.
What might misdirected laser energy cause to happen? |
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Definition
False. Patients must remain completely immobile due to a critical focus of the laser beam--any movement may divert the beam to adjacent normal tissue.
It may perforate a viscus (internal organ with a cavity) or large blood vessel. Energy transfer may also result in ocular injury (corneal or retinal)--wear safety goggles. |
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Term
| What 2 airway complications are common after laser surgery in the larynx and pharynx? |
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Definition
| Bronchospasm and laryngospasm |
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Term
| What are some advantages of laser surgery? |
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Definition
Hemostatic operative environment
Decreased blood loss
Decreased edema
Decreased scarring
Less post op pain
No touch technique
Decreased recovery time, hospital time
Decreased sick time (loss of work, function) |
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Term
| What is a by-product of tissue vaporization, and what are the implications for OR workers? |
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Definition
| Smoke plume--fine particulates can be inhaled into the alveoli and transmit microbacterial disease. Wear high efficiency masks, use of efficient smoke evacuator |
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Term
| How do we protect patients eyes from laser injury? |
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Definition
| Patient's eyes are closed, taped, and covered with a protective shield such as soaked saline pads. |
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Term
What surgical instruments might cause airway fires?
What types of ETTs are highly flammable? |
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Definition
Laser or cautery
PVC tubes--they should not be used. |
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Term
What can be done to reduce the flammability of ETTs?
What is a Xomed tube? |
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Definition
Wrapping the ETT with a special metallic foil (Merocel)
An ETT that has a laser resistant coating of aluminum powder in silicone. Expensive ($200-300!!) |
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Term
| How can we reduce the risk of airway fires? (4 ways) |
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Definition
1. Decrease the FiO2 to less than 40% (as pt condition allows)
2. Avoid nitrous (supports combustion)
3. Use apneic technic
4. Substitute helium for air--this delays ignition, and also has lower viscosity than nitrogen, which allows the use of a smaller ETT without turbulence and high resistance. |
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Term
| What might you do different with the ETT cuff during a laser ENT surgery? Why? |
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Definition
Inflate the cuff with methylene tinged saline
The color alerts the surgeon to puncture of the cuff, the saline absorbs heat, and a fine spray of saline may put out the airway fire. |
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