October 2025 POCUS Case of the Month: Lung Ultrasound
Authors: Ying Hui Low, MD, FASA, FASE; Mitchell Fuller, MD; William Lao, MD
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Question of the Day
An otherwise healthy patient presents to have laryngeal nodules removed with a laser under general anesthesia. After the induction of anesthesia, a polyvinyl chloride ETT is placed and the patient is ventilated with 100% O2. While the surgeon is using the laser the ETT catches fire. Which of the following is MOST correct regarding airway fires and laser safety?
Question of the Day
An otherwise healthy patient presents to have laryngeal nodules removed with a laser under general anesthesia. After the induction of anesthesia, a polyvinyl chloride ETT is placed and the patient is ventilated with 100% O2. While the surgeon is using the laser the ETT catches fire. Which of the following is MOST correct regarding airway fires and laser safety?
Your Answer
Correct Answer
Explanation
Lasers pose a significant risk of fire when used around highly combustible gases. Use of a cuffed ETT will prevent the majority of airway gases delivered to the patient from reaching the pharynx. Additionally, using methylene blue dyed saline DOES indeed help to dissipate heat and if the cuff if ruptured the blue color that escapes into the pharynx will signal cuff rupture to the surgeon, thus signaling the potential for increased oxygen concentrations in the pharynx from escaped inhaled gases. A. The first step in an airway fire is for the anesthesiologist to immediately stop ventilation and REMOVE the endotracheal tube. B. Wrapping an ETT with metallic tape is not FDA approved. Additionally it adds thickness to the tube and may reflect laser onto nontargeted tissue. C. Silicone, in addition to polyvinyl chloride and red rubber, ETTs are highly combustible. Metal ETTs are combustion resistant.
References:
APSF: Fire Safety Video Surgical Fires Apfelbaum JL, Caplan RA, Barker SJ, 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;118(2):271-290. doi:10.1097/ALN.0b013e31827773d2
