Lasers are commonly used in operating rooms and procedure areas. When lasers are used for airway surgeries or for procedures involving the neck and face, the case should be considered as high risk for surgical fire and managed as previously discussed.The type of laser (CO2, neodymium yttrium aluminum garnet [NG:YAG], or potassium titanyl phosphate [KTP]), wavelength, and focal length are all important considerations for the safe operation of medical lasers. Without this vital information, operating room personnel cannot adequately protect themselves or the patient from harm. Before beginning laser surgery, the laser device shouldbe in the operating room, warning signs should be posted on the doors, and protective eyewear should be issued. The anesthesia provider should ensure that the warning signs and eyewear match the label-ing on the device as protection is specific to the type of laser. The American National Standards Institute (ANSI) standards specify that eyewear and laser devices must be labeled for the wavelength emitted or protection offered. Some ophthalmologic lasers and vascular mapping lasers have such a short focal length that protective eyewear is not needed. For other devices, protective goggles should be worn by personnel at all times during laser use, and eye pro-tection in the form of either goggles or protective eye patches should be used on the patient.
Laser endotracheal tube selection should be based on laser type and wavelength. The product insert and labeling for each type of tube should be compared to the type of laser used. Certain tech-nical limitations are present when selecting laser tubes. For instance, tubes less than 4.0 mm in diam-eter are not compatible with the ND:YAG or argon laser nor are ND:YAG-compatible tubes available in half sizes. Attempts to wrap conventional endotra-cheal tubes with foil should be avoided. This archaic method is not approved by either manufacturers or the U.S. Food and Drug Administration, is prone to breaking or unraveling, and does not confer pro-tection against laser penetration. Alternatively, jetventilation without an endotracheal tube can offer a reduced risk of airway fire.