Safety precautions for bronchoscopic Nd-YAG laser surgery.

The application of the neodymium-yttrium aluminum garnet (Nd-YAG) laser in bronchoscopy originated in Europe in 1981 and is now widespread in the United States. Transmissible through flexible fiberoptic quartz fibers and an efficient coagulator of tissue, the Nd-YAG laser deeply penetrates tissue not readily predictable by the endoscopist. Dangers associated with the Nd-YAG laser include complications secondary to inadvertent exposure to normal tissues or structures, tracheobronchial accidents (perforation, hemorrhage, fire), and complications related to anesthetic technique (respiratory depression). Hypoxemia related to persistent hemorrhage, accumulation of secretions or debris or both, or anesthesia-induced respiratory depression is the common denominator of most intraoperative and postoperative complications. Careful selection of patients, intraoperative monitoring of ventilation and blood gases, and techniques of rigid bronchoscopy are stressed to avoid complications.