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Chem and Physics llb


What is a laser A laser is a device that controls the way that energized atoms release protons.
What is the acronyms for laser Light amplification by Stimulated Emission of Radiation
Laser-light Laser light - very different from normal light. Laser light has other properties.
Monochromatic light It contains one specific wavelength of light ( one specific color). The wavelength of light is determined by the amount of energy released when the election drops to a lower orbit.
Coherent light It is "organized" --- each photon moves in step with the others. This means that all of the photons have wave fronts that launch in unison
Directional light A laser light has a very tight beam and is very strong and concentrated. A flashlight is contrast releases light I'm many directions, the light is very weak and diffused.
Energy emitted as photon (1) or absorbed by O2 (2)
Do you need protective eyewear when laser light are in use yes. and they have to be laser protective eyewear.
Do you look into a laser with remaining eye NO. do not look into laser with remaining eye.
Medical lasers Carbon dioxide, Nd-Yang, KTP and Argon laser.
Carbon Dioxide laser this laser is invisible ( marked w/helium-neon aiming beam.) Widely used for upper airway surgery
ND-Yang laser Neodymium-yttrium aluminum-garnet laser. this is a short wavelength allows transmission by fiber optics. Used on distal tracheobronchial tree and retina surgery.
KTP laser- Potassium-titanylphosphate laser. Can be transmitted by fiber optics. Used in neurosurgical and otolaryngeal surgeries
Argon Laser Can be transmitted by fribroptics. useful in neurological, retinal and otolaryngological procedures.
Laser wavelength to power The longer the wave length the lower the energy. and the shorter the wave length, the higher the energy
Long wave length low frequency, and low energy
Short wave length High frequency and high energy
Short wave length , high frequency and high energy Argon ( blue/green), KTP green
Longer wave length, low frequency and low energy Dye laser ( Red), Nd:YAG (infra red) CO2 (far infrared) and He-Ne (red)
CO2 Laser Longer wavelength = low frequency =lower energy. Greater wavelength =greater absorption by water Co2( Far infrared) - Relatively weak laser works on superficial tissues
Nd-YAG Shorter wavelength = Higher frequency = higher energy. Nd-YAG- Powerful laser. Coagulates and necrosis deeper tissues
Laser Surgeries of airway Lasers are frequently used for airway surgery including: -laryngeal papillomas -tracheal scaring -vascular malformations -neoplasms -idiopathic subglottic stenosis
Associated risks loss of airway fire burns eye damage
Preoperative preparation Antisialagogue Eye protections for OR personnel and patient Laser tube or ETT wrapped with laser tape
Airway concerns shared airway surgeon and anesthetist Airway obstruction foreign body Airway edema Obstructive mass/less
Induction Know airway patency! RSI vs smooth iv or mask induction -sevo? irritable airway OSA? -Unique concerns
Obstructive sleep apnea Floppy upper airways Redundant fat deposits lateral pharyngeal wall Sleep and Anesthesia = increased pharyngeal musculature relaxation and posterior tongue displacement Airway narrowing d/t startling resistor mode and Bernoulli effect
Considerations with OSA Denitrogeneat and hyperoxygenate Head of bed up Aware of pharyneal relaxing agents Sedatives, inductions agensts (propofol), VAAs, NMBA ( including low level residual effects) Intubation technique back ups
Maintenance of OSA Prevent loss of airway Shared airway : -Keep in close communication with surgeon -Closely monitor breath sounds and EtCo2
Prevent Burn injury Be aware of when laser are in use Do not look into laser Confirm laser in standby mode when not in use -Aiming beam vs power beam Do not allow laser to lay on drapes
Prevent eye injury Yours and the patient's -Lube pt eyes and tape shut Saline soaked eye pads to pt Laser goggles, not glassess on patient Appropriate laser glassess on all OR personnel Do not look into laser
Prevent inhalation injury Your and the patient's -Continually assess integrity of cuff -Do not breath laser plume -carcinogenic, toxic and contagious
Maintenance - anesthetic General anesthesia -VAA (sevo) or TVA -FiO2 40% or less. 21 % preferable -Avoid N2O- it supports combustion -Complete neuromuscular blockade -routine monitoring ---Precordial stethoscope? -Bottle saline/water immediately available
Maintenance in regards to laser Use "Laser" or protected endotracheal tube use laser tubes specific for laser use or wrap endotracheal tube in laser foil use smallest allowable tube for surgical exposure and ventilation usually 5.5 - 6.5 mm tube fill ET tube cuff with saline (dye?)
In case of airway fire what to you do? in case of fire Be prepared to Extinguish and treat Be prepared to emergently extubate patient in case of airway fire
If there is airway fire what to you do Immdediately stop all gas flow, cut pilot tube and extubate pt Extinguish with water and saline Re-intubate pt, ventilate with air only until no remaining fire confirmed. Ventilate with 100% oxygen Assess (DL & FOB) larynx, trachea bronchiole tree for
What are oxidizer N2O and oxygen
Ignition source boviies
Fuels drapes, ETT, oxygen tubing
In case of airway fire and you have extinguish the fire what do you do Assess larynx, trachea, bronchiole tree for damagegive give corticosteroids to decrease inflammation, give antibiotics for infections continued intubation/ventilation
Extubation Surgeon may request "deep " extubation Aireway blood may remain despite suctioning and laryngospasm Be sure any saline pledgets and throat packs have been removed by surgeon
Postoperative Laryngospasm risk due to irritation or remaining blood Observe for stridor, excessive coughing, and or bronchospasm intervene quickly
Laryngospasm Caused by vocal cord irritation Cricothroid muscle spasm Treatment: CPAP bymask. Attemp positive pressure ventilation <20 cm H2O. Jaw thrust at angle of Ramus-accupressure point succinylcholine if needed
What does cricothyroid muscle do? It increases the tension on the cord
Is the cricothyroid muscle the primary muscle responsible for laryngeal spasm? Yes
What are the two most common reasons why one will have difficulty ventilating Obstructions and Laryngeal spasm
If you are able to move air but not sufficient enough what should be your next move Place an LMA
How much suc should you give for laryngospasm 10 to 20 mg iv
Created by: eonaodow