Department of Anesthesia, Shanghai Eye and ENT Hospital, Fudan University, China.
Am J Otolaryngol. 2012 Nov-Dec;33(6):714-7. doi: 10.1016/j.amjoto.2012.06.005. Epub 2012 Aug 9.
We performed retrospective clinical analysis and in vitro testing to analyze the risks involved in laryngeal surgery using a CO(2) laser.
The occurrence of adverse events during laryngeal surgeries using a CO(2) laser, the reasons for these adverse events, and the risks of laryngeal laser surgery were analyzed in 704 patients. In vitro experiments were performed to observe the tolerance of the cuffs of polyvinylchloride (PVC) endotracheal tubes to the CO(2) laser under conditions of filling water or air, different laser power levels, and different cutting patterns. The flammability of the PVC endotracheal tube under different oxygen concentrations, laser power levels, and laser cutting patterns were also studied.
In the 704 patients who underwent laryngeal laser surgery, the tracheal cuff broke in 92 cases; sparks were observed in 8 cases; and dense smoke, in 27 cases during surgery. No fires or explosions occurred. The in vitro results were as follows: (1) Under the intermittent stimulation mode, the water cuff did not break, but the air cuff broke during the first stimulation. (2) Under the continuous stimulation mode, the water and air cuffs broke easily, and the water and air cuffs broke immediately when the stimulation power was greater than 8 W. (3) Under the intermittent stimulation mode, the PVC endotracheal tube burned only under conditions of pure oxygen supply and 10 W of laser power. Under the continuous stimulation mode, the tube did not burn with 5 W of laser power, regardless of the oxygen concentration used. When the laser power level reached 8 W and the oxygen concentration was greater than 50%, the tube will easily burn. When the laser power level was 10 W, the tube burned at oxygen concentrations greater than 20%.
Burning of the tube during laryngeal surgery using a CO(2) laser could be effectively avoided when appropriate measures were taken, such as filling the endotracheal cuff with water, maintaining less than 40% oxygen concentration, using less than 8 W laser power, and using the intermittent stimulation mode.
通过回顾性临床分析和体外试验，分析使用 CO2 激光进行喉部手术的风险。
对 704 例行 CO2 激光喉部手术的患者，分析手术中不良事件的发生原因，探讨激光喉部手术的风险。通过体外实验观察水或空气填充、不同激光功率水平和不同切割模式下聚氯乙烯（PVC）气管导管套囊对 CO2 激光的耐受程度，研究不同氧浓度、激光功率水平和激光切割模式下 PVC 气管导管的可燃性。
704 例行激光喉部手术的患者中，92 例气管套囊破裂，8 例出现火花，27 例出现浓烟，均未发生火灾或爆炸。体外实验结果如下：（1）间断刺激模式下，水囊未破裂，空气囊首次刺激即破裂；（2）连续刺激模式下，水囊和空气囊容易破裂，刺激功率大于 8 W 时水囊和空气囊立即破裂；（3）间断刺激模式下，纯氧供应和 10 W 激光功率下 PVC 气管导管仅燃烧，连续刺激模式下，5 W 激光功率下无论氧浓度如何均不燃烧，激光功率水平达到 8 W，氧浓度大于 50%时，导管容易燃烧，激光功率水平为 10 W 时，氧浓度大于 20%时导管燃烧。
采取合适的措施，如向气管导管套囊内注水、保持氧浓度低于 40%、使用低于 8 W 的激光功率、采用间断刺激模式，可有效避免 CO2 激光喉部手术中导管燃烧。
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