ELECTRIC EQUIPMENT 10 Laser Eye protection

Guidelines to Eye Protection during Laser Surgery

•     Ensure that everyone in the laser room is wearing the appropriate eye protection before activating the laser. The eye wear should have the laser wavelength protection and optical density of the lens material inscribed on it.

•     A special lens cover can be placed over the eyepiece of an endoscope to protect the physician’s eye from laser back­scatter. Remember that the physician’s other eye will be unprotected.

•     Everyone in the laser room should wear eye protection during laser endoscopic procedures.

•     An automatic lens shutter can be connected to a microscope head to provide eye protection for persons viewing the procedure through the microscope.

•     When general anesthesia is used, cover the patient’s closed eye with moistened gauze pads. When the patient is awake, place the appropriate glasses or goggles on the patient. Explain the need for eye protection to the patient.

•     During laser surgery near the eye, a special laser eye shield may be placed directly on the anesthetized eye surface.

•     Ensure that the appropriate protective eyewear is available at all entrances to the laser room for anyone entering the area.

•           When storing protective eyewear, guard against scratches and mishandling. Scratches on the lenses may decrease their effectiveness.

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ELECTRIC EQUIPMENT 9 Lasers

LASERS

Laser light is a part of the light spectrum which has been collimated and made coherent so that the waves travel in the same direction in parallel. This beam now carries laser energy measured in Joules and the energy delivered is proportionate to the exposure measured in seconds. The principle of laser generation has been shown in the figures above. New laser systems have been introduced into use. The five components of a system are:

•     Laser head

•     Excitation source

•     Ancillary components

•     Control panel

•     Delivery system.

      The Table 2.1 summarises the characteristics of those in use in surgery.

•     A laser is an instrument equipped to produce a parallel beam of high intensity light which can be focussed on a very small spot 

•     The development of surgical lasers during the last decade has made a significant contribution to microsurgery

•     Used with an operating microscopes or fiberscopes a wide range of microsurgical procedures have now become possible, for example:

      a.   Sutureless microvascular anastomosis.

      b.   Excision of the posterior capsule of the lens through the transparent cornea.

      c.   Coagulation of bleeding peptic ulcers using a flexible gastroscope.

•     In laser surgery, the light beam heats the target tissue and causes:

      a.   Thermal tissue destruction.

      b.   First with local edema.

      c.   Then denaturation of protein.

      d.   Contraction of tissue due to alteration of fibrous tissue protein.

      e.   And finally boiling of cell water and vaporization.

      f.    Generally, low energy exposure results in coagulation of blood vessel.

      g.   Higher energy exposure produces a precise incision by vaporization of the tissue at the focal point.

            It is important that eye protection be worn during procedures

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ELECTRIC EQUIPMENT 8 Surgical Cautrey

Surgical Cautery

•     Electric cautery is used to destroy superficial skin lesions. The wire tip is raised to red heat by means of an electric current

•     This heated cautery point is then applied to the tissue area to cause tissue death through coagulation

•     The current source may be a low-voltage battery or trans­former connected the mains, although the transformer is preferable, as the output is more constant than that of a battery

•     The transformer has a rheostat knob which may be adjusted to alter the voltage applied to the platinum point

•     The cautery must not be used any hotter than at red heat, as too high a current will cause rapid burning out of the cautery wire and reduce its life span

•     The cautery point are various sizes and shapes (Fig. 2.4) are mounted in a heat-resisting handle to which are connected two wires

•     These wires are then connected to the transformer which must be switched off at the wall socket

•     The cautery must be connected to the cautery terminals

•     After connecting the wires the transformer may then be switched on.

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ELECTRIC EQUIPMENT 7 surgical diathermy safety

Safety

Responsibility

The surgeon using the diathermy must realize his overall responsibility, and check the alarm wiring and patient plate before use.

Safety Measures

Alarms

Monopolar diathermy depends on the patient plate for its safety. All diathermy machines in use will alarm when switched on if the plate is not connected to the machine. Safe practice demands rigid adherence to correct procedures:

•     First the patient plate is connected to the patient

•     The return lead is connected to the plate

•     The diathermy machine is switched on 

•     The plate continuity alarm will sound

•     Then is the return lead connected to the diathermy machine.

•     Thus silencing the continuity alarm

•     The plate should be sited close to the operation

•     Diathermy current is moving away for ECG and other monitoring electrodes

•     The area under the plate should have a good blood supply to remove any heat generated

•     All plates must have good skin contact

•     Shave hairy skin and ensure the plate is not kinked or crinkled.

Patient

•     The patient should not touch earthed metal objects such as drip stands, uninsulated ‘screens’, and parts of the operating table

•     Check the dial settings before use

•     If a spirit-based skin preparation fluid is used, ensure it has all evaporated

•     Only the surgeon wielding the active electrode should activate the machine

•     Always replace the electrode in an insulated quiver after use

•     If diathermy performance is poor, carefully check the patient plate and lead rather than increase the dial settings.

 

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