Tracheostomy tube ignition during microlaryngeal surgery using diode laser: a case report

Area of Science:

• Anesthesiology
• Otolaryngology
• Laser Surgery

Background:

• Laser microlaryngeal surgery, particularly with diode lasers, carries a risk of tracheal tube ignition.
• High oxygen concentrations (FiO2) increase the flammability within the airway.
• Patients with pre-existing conditions like glottic stenosis may require specialized airway management.

Observation:

• A patient with glottic stenosis undergoing endoscopic arytenoidectomy experienced an airway fire at the tracheostomy tube during diode laser use with 60% FiO2.
• The fire caused damage and obstruction to the tracheostomy tube.
• Immediate disconnection of the anesthetic circuit and tracheostomy tube replacement were performed.

Findings:

• The airway fire was successfully managed without long-term adverse effects on the patient's upper airway.
• Key risk factors identified include elevated oxygen concentration, presence of combustible materials, and confined surgical spaces.
• Prompt recognition and intervention are crucial for mitigating complications.

Implications:

• This case underscores the critical need for heightened vigilance and specific safety protocols when using lasers in oxygen-enriched airway environments.
• Anesthesiologists and surgeons must be aware of the fire triangle (oxygen, fuel, ignition source) in the context of laser surgery.
• Further research into optimal oxygen delivery methods and fire-resistant equipment may be warranted to enhance patient safety.