December FY22

[kristenhorsman]

This month's journal article is presented by Kristen Roman. I chose an article titled " Anesthesia and Laser surgery"; the article discusses various types of lasers, risks involved with their use, and ways to mitigate those complications.

The articled is attached to the email sent out.

Please answer the following two questions:

1. What are some risks of using lasers in the OR? Have you experienced any of these complications yourself?

2. What are some safety precautions we can take to prevent or mitigate these risks?

[nanci]

1. What are some risks of using lasers in the OR? Have you experienced any of these complications yourself?
Some risks of laser use in the OR include: Surgical fires, Thermal trauma, vessel and viscus perforation, embolism, and air contamination.
Have experienced 2 OR fires over the past 18 years, however neither was due to use of lasers. One was a bair hugger malfunction and another was from electrocautery in an oxygen rich environment for a facial procedure. Perhaps I have experienced air contamination but not to the point of needing medical care for respiratory, ocular, nor dermatologic disease.

2. What are some safety precautions we can take to prevent or mitigate these risks?
Education on laser safety, risks of fire (fire triangle, prevention of surgical fires, how to respond to a fire), posted laser in use signs, appropriate laser safety goggles with side shields available and used by all staff, available items to combat fires should they happen, fit tested high filtration masks when needed for plume and air contaminants as well as use of smoke evacuators. All staff should be aware of where the fire extinguishers are located and how to use them. The continuation of fire safety during the time out process to identify location of extinguisher(s) and notify staff of risk assessment. Oxygen delivered as an air oxygen blend at less than 30% oxygen can be helpful. Abstain from using volatile anesthetic agents if possible when laser to the airway as they can turn into toxic compounds if there is a fire. Use of saline soaked towels or pads around face, eyes, where laser is to be used can also be helpful. Filling the endotracheal cuff with saline instead of air can be helpful in case of airway fire and cuff rupture.

[Katya]

1. most frequent risks of laser use in the OR include fires, heat trauma to skin, vessel and viscus perforation. I did not experience a fire in OR.
2. Safety precaution while laser in use: laser goggles to everybody in OR and patient, smoke evacuators, keep O2 less than 30 %, communicate with surgeon if O2 needs to come up, cover windows in OR and place notifications on OR doors about laser in use, making sure everybody in OR knows location of extinguishers, cover patients eyes and face with wet towel.

[Amy Swank]

1. What are some risks of using lasers in the O.R.? have you experienced any of these complications yourself?

Ocular trauma, thermal trauma/burns, vessel and viscus perforations, venous gas embolism, air contamination, surgical fires.
As far as I know, I have not knowingly experienced these complications - but time will tell regarding retinal damage and years long laser exposure, I suppose.

2. What are some of the safety precautions we can take to prevent or mitigate these risks?

Prevention of thermal trauma (avoidance of shiny cabinets, instruments, equipment in the OR where laser procedure is being done), saline-soaked towels around path of beam, long-sleeved jackets, gloves, face shields for personnel in room.
Ocular trauma (use appropriate laser goggles for OR personnel and awake patients for the type of lasers (hint/fun fact - the type of goggle is posted on the laser machine).
Prevention of air contamination - suction nozzle within 2 inches of surgical site. appropriate masks to avoid inhalation of LGACs,
Fire prevention: fire risk assessment during timeout, normal saline syringes available readily for airway fire, avoid excessive tape, availability of CO2 fire extinguisher, avoiding the use of high concentrations of oxygen during laser use (less than 30%).

[Jennifer Hannon]

1. Risks of laser use in the OR include fires, heat trauma to skin, and perforation. As an SRNA we had an airway flare up once, the Scrub RN was quick to dose the fire.
2. laser goggles to everybody in OR and patient, smoke evacuators, keep O2 less than 30 %.

[Soo-Ok Kim]

1. fires related to airway cases, thermal injury to skin, vessel, and viscus., embolism, respiratory, ocular, and dermatologic disease. I have not experienced any laser related injury in my career.
2. wearing eye protections, saline soaked towel to the area to decrease thermal trauma, use smoke evacuator, keeping O2 to room air, wearing high filtration masks, avoiding excessive taping, available CO2 fire extinguisher, etc

[Amy Schutter]

1. Some risks with using Laser in the OR include ocular trauma, airway fires, thermal injury to skin. Thankfully, I have not experienced any of these injuries related to use of laser.
2. Some safety precautions to mitigate these complications are to always use appropriate safety goggles, use of smoke evacuators, saline soaked towels to surrounding areas and also to maintain O2 at less than 30%.