Airway ignition during co₂ laser laryngeal surgery and high frequency jet ventilation

Abstract

We present a case of a patient submitted for extirpation of a neoplasm of the larynx, by means of carbon dioxide laser surgery. High frequency jet ventilation was applied by means of orotracheal intubation with two Teflon catheters, 2mm in external diameter and 30cm in length, attached with three equally placed strips of adhesive paper tape. One catheter was used to inject the jet volume and the other used to measure the airway pressure. The adhesive strips were moistened and FiO₂ was lower than 50%. After 30 min using the laser, an airway fire was noticed. Ventilation was interrupted and the catheters were removed. The patient was reintubated with an endotracheal tube of 6mm ID and the surgical procedure was continued until the tumour was removed. Two factors contributed to the airway fire: the ignition of the lowest adhesive strip that had dried and the use of the laser in the mode of continuous pulsation.