Anaes · Head & neck / ENT anaesthesia
Shared airway laser surgery and airway fire: triad, prevention, algorithm
Also known as Airway fire algorithm · Laser airway anaesthesia · Fire triad OR
Shared airway principles for laser laryngeal surgery, fire triad, laser-safe tubes, FiO2 and nitrous rules, saline-filled cuffs, and the airway fire emergency algorithm.
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Red flags
- Airway fire is the canonical ENT crisis — know the algorithm cold.
- Fire triad: fuel + oxidiser + ignition; remove any one to prevent.
- Keep FiO2 as low as tolerable; avoid N2O as oxidiser.
- Laser-resistant tube; cuff with saline ± methylene blue; wet packs.
- If fire: stop laser/gases, remove tube, saline flush, re-establish airway, bronchoscopy.
Meet the patient
A 55-year-old smoker is on the table for CO2 laser cordectomy for a T1 glottic tumour. The surgeon has the laser armed, the FiO2 is running at 0.30 on air, and the laser-resistant tube sits with a saline-tinted cuff behind the cords. Three minutes into the first laser burst, you smell smoke and see an orange glow at the tube tip.[1]
That glow is an airway fire, and the response must be immediate. The algorithm is stop-remove-douse-secure — not freeze-and-think. Everyone who works in a laser airway list must be able to run it from muscle memory.[1]
References3ShowHide
- [1]Apfelbaum JL et al. Practice advisory for the prevention and management of operating room fires: an updated report by the American Society of Anesthesiologists Task Force on Operating Room Fires Anesthesiology, 2013.PMID 23287706
- [2]Cook TM et al. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia Br J Anaesth, 2011.PMID 21447488
- [3]Frerk C et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults Br J Anaesth, 2015.PMID 26556848