[70419]
Pt. Has history of vocal cord carcinoma treated previously with radiation therapy and laser ablation. Had been left with scar tissue web between vocal cords. To surgery for laser division of laryngeal web. This pt was identified in the holding area and taken to the operating room. He was placed supine on the operating room table and general endotracheal anesthesia was induced. The table was turned 90 degrees and a laryngoscope was introduced into the pt's oral cavity. This was suspended from laser arm with sharplan laser set on 5 watts and attached to micro manipulator. Anterior vocal cord web was divided in a posterior to anterior direction, however, very shortly after beginning division of the vocal cord web, during which time only about 1 mm of web had been divided, laser tube was struck with a brief laser burst and immediately caught fire. A large amount of smoke began issuing forth from endotracheal tube which was removed as quickly as possible and pt's oral cavity was filled with water. This was then suctioned clear and a new endotracheal tube was placed. Pt was ventilated through this while rigid bronchoscopy was brought in. Ventilating bronchoscope was used and it was seen that there were some pieces of ash in pt's posterior trachea; these were removed with forceps and trachea was lavaged with normal saline which was then suctioned clear. There was no full thickness mucosal burns, there were simply superficial burns of the proximal trachea. Pt was then extubated, awakened and transferred to floor. He was in stable condition and required substantial amounts of supplemental oxygen to maintain oxygen saturation in mid 90s.
Patient Sequence No: 1, Text Type: D, B5