{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T21:32:16Z","timestamp":1790371936423,"version":"4.1.0"},"reference-count":27,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,8,24]],"date-time":"2025-08-24T00:00:00Z","timestamp":1755993600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,8,24]],"date-time":"2025-08-24T00:00:00Z","timestamp":1755993600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2026,2]]},"abstract":"ABSTRACT<\/jats:title>\n \n Introduction<\/jats:title>\n \n The potential for airway fire during endoscopic laser surgery is well known, typically addressed by reducing FiO\n 2<\/jats:sub>\n levels. This study revisits these established practices in CO\n 2<\/jats:sub>\n laser tubeless airway surgery.\n <\/jats:p>\n <\/jats:sec>\n \n Materials and Methods<\/jats:title>\n \n Using a cadaveric porcine larynx and lung model, we conducted trials with high\u2010flow (HFV) and jet ventilation. We varied FiO\n 2<\/jats:sub>\n levels and laser power settings to record the onset and number of brief, expansive, and blowtorch flames.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Flames were observed in all jet ventilation trials. Multivariable model results showed that increasing laser wattage decreased onset times for expansive\/blowtorch flames and increased their frequency (\n p<\/jats:italic>\n \u2009<\u20090.05). Increased FiO\n 2<\/jats:sub>\n changes were not significant (\n p<\/jats:italic>\n \u2009>\u20090.05). HFV trials revealed no expansive flames at 4\u2009W at 100%, 6\u2009W at 70%, and 10\u2009W at 50% FiO\n 2<\/jats:sub>\n . Increasing wattage shortened flame onset and increased frequency across all flames (\n p<\/jats:italic>\n \u2009<\u20090.01), while increasing FiO\n 2<\/jats:sub>\n only reduced onset time for brief flames (\n p<\/jats:italic>\n \u2009<\u20090.05). Jet ventilation led to higher flame incidence and shorter onset times than HFV (\n p<\/jats:italic>\n \u2009<\u20090.05).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n Fire risk during CO\n 2<\/jats:sub>\n laser surgery in oxygen\u2010rich environments is influenced more by wattage, rather than FiO\n 2<\/jats:sub>\n levels. Jet ventilation consistently produced expansive flames, even at lower FiO\n 2<\/jats:sub>\n levels and wattage, supporting a FiO\n 2<\/jats:sub>\n limit of 30% for this ventilation technique. Our findings support HFV as a potentially safer option for CO\n 2<\/jats:sub>\n laser surgery, with safe zones of 4\u2009W at 100%, 6\u2009W at 70%, and 10\u2009W at 50% FiO\n 2<\/jats:sub>\n , provided laser application is under 30\u2009s. Our model's calculation of excess risk from wattage increments can help surgeons assess this fire risk.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/lary.70078","type":"journal-article","created":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T05:36:03Z","timestamp":1756100163000},"page":"882-889","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Revisiting Fire Safety Guidelines in\n \n CO\n 2<\/sub>\n <\/scp>\n Laser Airway Surgery"],"prefix":"10.1002","volume":"136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5080-0522","authenticated-orcid":false,"given":"Ariel","family":"Roitman","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery, School of Medicine and Public Health University of Wisconsin\u2010Madison Madison Wisconsin USA"},{"name":"The Ruth and Bruce Rappaport Faculty of Medicine Technion\u2014Israel Institute of Technology Haifa Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3299-3014","authenticated-orcid":false,"given":"Seth H.","family":"Dailey","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery, School of Medicine and Public Health University of Wisconsin\u2010Madison Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Bowen","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery, School of Medicine and Public Health University of Wisconsin\u2010Madison Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristopher M.","family":"Schroeder","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan L.","family":"Thibeault","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery, School of Medicine and Public Health University of Wisconsin\u2010Madison Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,24]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348948109000207"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.1980.00790340047012"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2022.103605"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/lsm.10174"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599814555853"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010021\u201004636\u20103"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215108003101"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/019459988609500109"},{"issue":"8","key":"e_1_2_9_10_1","first-page":"1","article-title":"Laser Safety in Otolaryngology\u2014Head and Neck Surgery: Anesthetic and Educational Considerations for Laryngeal Surgery","volume":"99","author":"Ossoff R. 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