Airway Fire during Laser Surgery and Jet Ventilation Steven Hur CA-1, Oana Maties MD, Valeria Cárcamo-Cavazos CA-1, Michael Jung CA-1 UCSF Mission Bay, 12/21/2016 Background: The incidence of... [ view full abstract ]
Airway Fire during Laser Surgery and Jet Ventilation
Steven Hur CA-1, Oana Maties MD, Valeria Cárcamo-Cavazos CA-1, Michael Jung CA-1
UCSF Mission Bay, 12/21/2016
Background: The incidence of airway fires in the US is estimated to 550-650 a year out of 65 million annual surgeries. Most occur in the outpatient setting and 34% involve the airway. The fire triad consists of three components required to start a fire. They include a fuel source (ETT, TEP), an oxidizer (O2, Nitrous Oxide) and an ignition source (Laser, Fiberoptic light source, ESUs). Fire risk should be assessed prior to every case by the multidisciplinary OR team as prevention is paramount.
Case Description: An 84 year old male with recurrent tracheal papillomatosis was scheduled for a routine CO2 laser ablation. Past medical history was significant for squamous cell cancer of the larynx with subsequent total laryngectomy 15 years ago and tracheal stoma creation. Of importance was the patient’s plastic tracheal esophageal prosthesis, in place day of surgery. The patient was pre-oxygenated with an infant mask over the stoma and general anesthesia was induced with lidocaine, propofol, fentanyl and rocuronium. Anesthesia was maintained with remifentanil and propofol infusions. Intermittent jet ventilation was used to provide oxygenation and ventilation, which the patient tolerated well and without desaturations. Jet ventilation was provided in conjunction with the male Oossof Pilling laryngoscope inserted into the patient’s tracheal stoma. A Hopkins rod telescope was used to perform tracheostomy and bronchoscopy. CO2 laser ablation was used to ablate lesions mostly located in the proximal to mid trachea. While working near the stoma, at the level of the TEP, a sudden spark was observed and it was apparent that the plastic handle of the TEP was burned through. Ventilation was immediately halted; irrigation was injected directly into the scope. The airway was suctioned and examined for any debris. A small fragment of the TEP handle was removed, but no mucosal damage was noticed. Apnea was less than one minute and jet ventilation was resumed.The patient was mask ventilated on emergence and had an uneventful recovery. ENT was consulted and the TEP was eventually replaced.
Discussion: Should an airway fire occur, immediate actions should include removal of the ETT and fuel source, removal of airway debris, pouring saline or water into the airway, and examination (including bronchoscopy) to assess for airway injury and residual debris. The anesthesia provider should stop all airway gas, re-establish ventilation while minimizing oxygen once the fire is extinguished, and consider reintubation in anticipation of airway swelling.
