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H.E. Greenman, J. Woodward; The Safety of Substances Used During CO2 Laser Surgery . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4456.
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Purpose: The use of the CO2 laser has greatly decreased intraoperative bleeding and operating time. With the benefits of the laser come hazards such as fires in the operating room. There have been case reports of intraoperative fires from the use of supplemental oxygen during laser surgery. There have also been anecdotes of substances used to prep the skin or placed on the skin catching fire. Furthermore, reports have documented the ignition of chlorhexidine and benzylkonium chloride in an alcohol base with cautery. There is one documented case in which a tube of petroleum based lubricant was set on fire with an unknown laser fluence and another where lacrilube and bacitracin ointment were found only to vaporize. Our study seeks to determine if common substances used on the skin during surgery are flammable at standard CO2 laser settings. Methods: Substances tested were aquaphor(petrolatum, mineral oil, lanolin alcohol, panthenol, glycerin, bisabolol), benzalkonium chloride(1:750), alcohol prep pad(saturated with 70% isopropyl alcohol), 10% providone-iodine solution, eryrhromycin(5mg/gram in a base of mineral ointment and white petrolaum), Polysporin(polymyxin b sulfate10,000 units and bacitracin zinc 500 units in white petrolatum base), triple antibiotic ointment(neomycin 3.5mg, polymyxin B sulfate 5000units, bacitracin zince 400 units in a base of white petrolatum), Tears Renewed(White petrolatum 88%, Mineral oil 12%), EMLA(lidocaine 2.5%, prilocaine 2.5%), Chlorhexidine(Chlorhexidine 4%, isopropyl alcohol 4%).Wooden tongue depressors were marked off at 1cm intervals for a total length of 6cm. Each substance was placed on one premarked tongue depressor at a thickness of 1mm. The CO2 laser (Coherent) was set at a power of 6 watts continuous mode with a 0.2mm beam width. The laser was held less than l cm from the target and then moved across a tongue depressor at a constant rate of 1 cm/second giving a uniform amount of energy per area of 300J/cm2(calculated fluence)applied to the substances which were monitored for vaporization, smoke, and fire. The laser was then set on pattern 3, size 9, density 6, 350 mJ, 60W. Three areas were resurfaced over each tongue depressor. The first one consisted of one pass, the next two passes and the third three passes. Substances were again recorded for vaporization, smoke and fire. Results: None of the substances were seen to catch fire at the above laser settings. The erythromycin, bacitracin, triple antibiotic, aquaphor, Tears Renewed ointments melted and vaporized. Conclusions: Petroleum based ointments had previously been documented to cause fire if ignited with a laser. The above substances appear to be safe at the standard laser settings.
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