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Management of Intratracheal Fire During Laser Surgery

2002; Lippincott Williams & Wilkins; Volume: 95; Issue: 2 Linguagem: Inglês

10.1097/00000539-200208000-00066

1526-7598

Peter Lierz, Anja Heinatz, Burkhard Gustorff, Peter Felleiter,

Head and Neck Surgical Oncology

To the Editor: We read with interest the article by Barker and Polson (1). We too consider a plan for possible emergencies during operations to be infinitely important and can only endorse Barkers and Polson’s recommendations. An intratracheal fire represents an unusual but nevertheless possible complication during laser surgery in the tracheobronchial system (2–6). The incidence of fire in the respiratory tract during laser surgery is stated as being between 0,4% and 1,5%(7). A plan should therefore be in place to avoid this catastrophic complication, or, in the event (2,6). Complete wrapping of the tube in film or the use of special tubes (2,4) to protect the tube in case of damage caused by laser. In the case of fire in the respiratory tract at least two syringes filled with sodium chloride should always be at the ready to extinguish the fire. The patient’s eyes should be covered by swabs soaked in sodium chloride. Oil–Water based ointments should be avoided as these could be set on fire by the laser beam (8). In the event of the tube catching fire its immediate removal is necessary. It should therefore, not be unduly secured and be easily accessible for the anesthetist (8). When undertaking laser surgery in the tracheobronchial system a PEEP from +5 to +10 cm H20 should be chosen. The permanent pressure inside the tube reduces the incidence of inflammation caused by the perforation of the tube (6). During a tube explosion the positive pressure in the lung counteracts the flame or the cloud of explosive gases, preventing hot toxic gases from penetrating the lower respiratory tract (3). The reduction of the inspiratory oxygen concentration to less than 30% clearly reduces the risk of inflammation or explosion in the respiratory tract (3,9). The possibility of a sudden tracheotomy during intratracheal laser surgery, in case of fire (4). In the case of fire, and when a total IV anesthetic was not administered, the supply of all anesthetic gases, including oxygen, should be cut off immediately and the tube disconnected. Highly dosed corticosteroids are recommended after the fire has been extinguished and 100% oxygen, given by mask, should be administered (8). The above points can help make laser surgery in the tracheobronchial system safer and also control possible complications more easily. Peter Lierz, MD Anja Heinatz, MD Burkhard Gustorff, MD, DEAA Peter Felleiter, MD