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American National Standard (ANSI) for Safe Use of Lasers in Health Care Facilities Z136.3 is the authority for medical laser safety in the United States. All surgical lasers are secured with a key lock and separate interlock required to operate the machine. A designated Laser Safety Officer responsible for lock security, warning signs during surgery, and other required safety measures are advisable.

Appropriate eye protection is required for all surgical laser wavelengths. Clear glass with protection from all angles is adequate for the CO₂ laser, but optical density recommendations are specific for the near‐infrared and other wavelengths and should be followed for the specific laser. The patient’s eyes must be considered as well. Since surgical lasers discussed here are not in the visible spectrum, a low energy helium‐neon laser aiming beam is used. However, prolonged direct exposure, particularly to the eye, can still cause damage.

All smoke generated from tissue should be evacuated using a filtered laser smoke evacuator. In spite of reports that insignificant concentrations of bacteria become aerosolized [28] and that horses are not adversely affected by routine upper airway laser surgery [29], there is sufficient evidence that infectious, carcinogenic and irritant material is present in laser smoke [30, 31]. The vaporized debris and potentially viable cells or pathogens should not be inhaled by humans or the patient. Surgical suction is inadequate for this task because it is less efficient, and the suction lines will eventually foul.

The surgical field should be protected by barriers. Towels or lap sponges soaked with sterile water or saline limit CO₂ laser energy from burning tissue off the field or drapes. Wet sponges should be held behind tissue that the laser could penetrate completely. Laser beams reflected from metallic surgical instruments retain sufficient energy to affect tissue or personnel. Anodized or matte finished instruments to limit reflection can be purchased.

Accelerants should be avoided. Saline should be used instead of alcohol for surgical prep. Heliox (oxygen diluted with helium) can be substituted for pure oxygen when operating close to the airway with the horse under general anesthesia. If these few simple rules are followed, laser surgery is as safe as any other surgery.