title: Hazard of CO₂ laser-induced airway fire in laryngeal surgery: experimental data of contributing factors.
abstract: In carbon dioxide (CO2) laser surgery of the larynx, the potentially dangerous combination of laser-induced heat in an oxygen-enriched atmosphere typically occurs when jet ventilation is used or due to an insufficiently blocked endotracheal tube. Until now, no limitations for safe oxygen concentrations or laser intervals have been established. The aim of this study was to investigate and quantify the factors that may contribute to an airway fire in laryngeal laser surgery. Fat, muscle and cartilage were irradiated with a CO2 laser at 2, 4, 6 and 8 W in five different oxygen concentrations with and without smoke exhaustion. The time to ignition was recorded for each different experimental setup. Fat burnt fastest, followed by cartilage and muscle. The elevation of laser energy or oxygen concentration reduced the time to inflammation of any tissue. The elevation of oxygen by 10 % increases the risk of inflammation more than the elevation of laser power by 2 W. Under smoke exhaustion, inflammation and burning occurred delayed or were even inhibited at lower oxygen concentrations. Lasing in more than 50 % oxygen is comparatively dangerous and can cause airway fire in less than 5 s, especially when laser energies of more than 5 W are applied. In equal or lower than 50 % oxygen, an irradiation interval of 5 s can be considered a comparatively safe time limit to prevent inflammation in laryngeal laser surgery. Smoke exhaustion should always be applied.
authors: Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Kerpener Str. 62, 50924 Cologne, Germany. konrad.stuermer@uk-koeln.de
authors: Konrad Johannes
authors: KJ
authors: Stuermer
authors: Stefan
authors: S
authors: Ayachi
authors: Antoniu-O
authors: AO
authors: Gostian
authors: Dirk
authors: D
authors: Beutner
authors: Karl-Bernd
authors: KB
authors: Hüttenbrink
mesh_terms: D004869:Equipment Safety; D005390:Fires / Q000517:prevention & control* / Q000706:statistics & numerical data; D006611:High-Frequency Jet Ventilation / Q000009:adverse effects; D006801:Humans; D007442:Intubation, Intratracheal; D007830:Larynx / Q000601:surgery*; D053685:Laser Therapy / Q000009:adverse effects*; D054020:Lasers, Gas / Q000009:adverse effects*; D008953:Models, Anatomic; D010100:Oxygen; D012307:Risk Factors
chemical_list: D010100:Oxygen
references: Anesth Analg. 1983 Feb;62(2):218-29
references: 6338757
references: Arch Otolaryngol. 1979 Sep;105(9):561-2
references: 573110
references: Anaesthesist. 1999 Sep;48(9):669-85
references: 10525603
references: HNO. 2008 Dec;56(12):1197-206
references: 19020846
references: Laryngoscope. 1983 Mar;93(3):275-8
references: 6403785
references: Thorac Cardiovasc Surg. 1988 Jun;36 Suppl 2:118-25
references: 3046051
references: Kurume Med J. 1980;27(3):157-65
references: 6787300
references: Laryngoscope. 1989 Aug;99(8 Pt 2 Suppl 48):1-26
references: 2666808
references: Anaesthesist. 2006 May;55(5):541-6
references: 16432741
references: IEEE Trans Biomed Eng. 1980 Mar;27(3):164-6
references: 7358420
references: Eur J Anaesthesiol. 2000 Mar;17(3):204-7
references: 10758472
references: Paediatr Anaesth. 2004 Jan;14(1):90-4
references: 14717879
references: Anesthesiology. 1992 Mar;76(3):468-9
references: 1539860
references: Anesth Analg. 2002 Aug;95(2):502
references: 12145090
references: Anaesthesist. 2001 Sep;50(9):721-34; quiz 735, 737
references: 11593883
references: Lasers Surg Med. 2003;32(5):384-90
references: 12766961
references: Neurosurg Rev. 1984;7(2-3):113-121
references: 6436734
references: Ann Otol Rhinol Laryngol. 1972 Dec;81(6):791-8
references: 4636137
references: Ann N Y Acad Sci. 1976 Jan 30;267:263-94
references: 1064357
references: Anaesthesist. 2010 Nov;59(11):1051-61; quiz 1062-3
references: 21060980
references: Arch Otolaryngol Head Neck Surg. 1992 Jul;118(7):722-4
references: 1627293
references: Acta Anaesthesiol Scand. 1972;16(3):176-87
references: 4566465
references: Curr Opin Otolaryngol Head Neck Surg. 2007 Apr;15(2):82-8
references: 17413407
references: J Voice. 2010 Jan;24(1):102-9
references: 19487102