General Anesthesia Considerations in Co2 Laser Surgery in ENT

Laser surgery under general anesthesia demands a high level of cooperation between surgical and anesthetist as there are lot of risks involved in laser surgery in the upper airway. Risks include airway fire, damage to healthy tissue, and injury to theatre staff. There should be good teamwork in theatre. All staff must be familiar with laser surgery and local safety policies. While the majority of procedures pose few problems beyond protection of the eyes of operating room personnel and patients, surgery with the CO2 laser requires very careful anesthetic management.
Nitrous oxide and high concentrations of oxygen support combustion and should be avoided. The use of specifically-designed laser tubes that resist damage and dissipate the high energy of the laser, thus diminishing the risk of tube fire and reflection damage to adjacent tissue.
A preoperative visit to determine the degree of existing airway obstruction is mandatory in deciding the safest anesthetic technique. Continued communication and cooperation between the surgeon and anesthesiologist throughout the procedure will help minimize the conflicting needs for airway access and ventilation.
The choice of anesthetic technique is dictated by the experience of the anesthetist.