[Does a high inspired oxygen concentration consistently play a key role in developing combustion in the airway during fiberoptic bronchoscopy guided laser treatment?--A case of firing in the airway under total intravenous anesthesia].
We experienced combustion of a fiberoptic bronchoscope and an endotracheal tube, as well as tracheo-bronchial burn during a diode laser treatment in a hypoxemic patient requiring continuous oxygen administration. Total intravenous anesthesia and a high concentration of inspired oxygen (FIO2 0.60) were used for the procedure. The complication occurred abruptly at the beginning of the second treatment after the first uneventful 15 min treatment. Several reports suggest that laser treatment can be performed even under FIO2 1.0 without firing in the airway, and a high FIO2 itself would not consistently play a key role in developing combustion in the airway, even though combustion is more vigorous when a higher FIO2 is used. Based on our experience and reports of firing in the airway during laser treatment, the following recommendations are presented. The laser treatment should be done (1) at the FIO2 just enough to maintain adequate oxygenation in each individual patient, (2) at the greatest possible distance between a bronchoscope and an endotracheal tube, and (3) after removing small pieces of carbonized tissues produced by each laser treatment.
Ishihara
Hironori
H
Department of Anesthesiology, University of Hirosaki School of Medicine, Hirosaki 036-8562.
Takahira
Yoko
Y
Muraoka
Masatoshi
M
Hashimoto
Hiroshi
H
Matsuki
Akitomo
A
Hasegawa
Yukihiro
Y
Takanashi
Shingo
S
D000771:Anesthesia, Intravenous; D001984:Bronchial Neoplasms / Q000601:surgery*; D001999:Bronchoscopy / Q000009:adverse effects*; D002059:Burns, Inhalation / Q000209:etiology*; D017809:Fatal Outcome; D005336:Fiber Optic Technology; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000009:adverse effects*; D007442:Intubation, Intratracheal; D017075:Laser Coagulation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000008:administration & dosage*
D010100:Oxygen