"Blow-torch phenomenon" during laser assisted excision of a thyroglossal cyst at the base of the tongue

Abstract

We report a case of blow-torch phenomenon encountered during diode laser assisted excision of a thyroglossal cyst in a child. This is first such case report from India and highlights an unusual complication which anesthesiologists need to be aware of due to the increasing use of operative laser.

Guidelines in Practice: A Safe Environment of Care

“…15 The tip of the laser slipped and touched the endotracheal tube, an audible "pop" was heard, and the odor of smoke was noted from the exhaled gas of the expiratory valve for approximately one minute. 15 Oxygen was discontinued and the patient was ventilated with air; no injuries were sustained. Upon examination of the endotracheal tube after extubation, the tube was found to contain a small circular hole, and the inner portion of the tube was black distal to the hole.…”

“…The anesthesia professional reiterated the importance of using laser-resistant endotracheal tubes, filling the cuff with tinted saline, and using moistened sponges and rewetting them as needed near oxidizers and ignition sources. 15 Because dry sponges are a common fuel source, the American Society of Anesthesiologists recommends that when using sponges near an ignition source, especially near the airway, the sponges should be moistened to reduce their flammability. 16 If a surgical fire occurs, AORN recommends that team debriefings and screenings for symptoms of workplace trauma (eg, rumination about the event, sleep disturbances) should be offered to all team members involved in the incident before they return to clinical work.…”

“…The perioperative team should use moistened radiopaque sponges near oxidizers and ignition sources and instill a tinted solution when inflating the endotracheal tube to minimize the potential for airway fires during airway surgical procedures 6 . A case report of “blow‐torch phenomenon” during a diode laser–assisted excision of a thyroglossal cyst in a pediatric patient described the removal of a saline‐soaked throat pack to facilitate surgery because the surgeon's vision was obstructed and they were restricted from pulling the tongue outward 15 . The tip of the laser slipped and touched the endotracheal tube, an audible “pop” was heard, and the odor of smoke was noted from the exhaled gas of the expiratory valve for approximately one minute 15 .…”

“…A case report of “blow‐torch phenomenon” during a diode laser–assisted excision of a thyroglossal cyst in a pediatric patient described the removal of a saline‐soaked throat pack to facilitate surgery because the surgeon's vision was obstructed and they were restricted from pulling the tongue outward 15 . The tip of the laser slipped and touched the endotracheal tube, an audible “pop” was heard, and the odor of smoke was noted from the exhaled gas of the expiratory valve for approximately one minute 15 . Oxygen was discontinued and the patient was ventilated with air; no injuries were sustained.…”

Endotracheal Tubes: Old and NewDiscussion

“…30 In particular, fires involving the ETT have been reported using the neodymium:yttrium aluminum garnet 31,32 and carbon dioxide [33][34][35] lasers, as well as the new diode laser. 36 Investigators have studied the incendiary characteristics of various ETT materials. 34,[37][38][39] The standard red rubber and PVC tubes readily ignite, particularly at high F IO 2 and in the presence of N 2 O, but resist ignition when wrapped with copper or aluminum foil.…”