The flash-lamp pumped pulsed dye laser is the current treatment of choice for cutaneous port-wine stains. In our practice, most children with these lesions are treated under general anesthesia. At energy levels used clinically, it is possible to ignite hair in the presence of supplemental oxygen; we are aware of four cases in which either the eyebrows or eyelashes were ignited during the administration of general anesthesia via a face mask. The laryngeal mask airway (LMA) recently has become widely available and this device might decrease the risk of fire during treatment of these lesions. We therefore designed this study to examine the extent of oxygen leakage under the mask during clinical cases, and to compare this with the leakage present with the LMA. A total of 20 patients aged 4 mo to 16 yr were studied on 26 separate occasions. During spontaneous ventilation, high concentrations of oxygen leaked around the mask in every case (mean 63% ± 16%), but in only one case was a concentration more than 21% detected around the LMA (P < 0.001). During controlled ventilation with the LMA, oxygen leaked around the mask in 19% of cases. Use of the LMA markedly decreases the incidence of potential oxygen leakage into the laser field, and is recommended for use, with preservation of spontaneous ventilation, during these cases. We suggest measuring oxygen concentrations at the mouth for laser treatment of facial port-wine stains to confirm that the larynx has been isolated. Anesthesia via a mask with oxygen and nitrous oxide should not be used while lesions around the eyes are treated, due to the risk of igniting the eyebrows or eyelashes.
ASJC Scopus subject areas
- Anesthesiology and Pain Medicine