OTO: Surgical Fires in Laser Laryngeal Surgery: Are We Safe Enough?

This podcast highlights original research in the January 2015 issue of Otolaryngology - Head and Neck Surgery, the official journal of the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) Foundation. Editor in chief John Krouse is joined by authors Soham Roy and Lee Smith and associate editor Kenneth Altman in discussing the issue of airway fires in the operating room during laser laryngeal surgery.     Airway fires continue to be a dreaded complication of laser laryngeal surgery.  Prior work by the authors has demonstrated that endoscopic airway surgery remains the most frequent cause of operating room fires.  In the current study, Roy and Smith employ a simulated laser surgical environment in which they utilize a mannequin model to vary the parameters of inspired oxygen concentration and examine various maneuvers designed to decrease the incidence and morbidity of airway fires.  Their study demonstrates that sustained airway fires occur at 40% FiO2 and above, while O2 concentrations of 29% or lower demonstrate flaming briefly, if at all.  In addition, the authors note that cuffs strikes are a significant risk for fires, and that wet pledgets are not an absolutely protection from these events.  The authors discuss the important implications of their paper and provide guidance for decreasing the risk of airway fires during laser laryngeal surgery.