One of the most feared complications of laser surgery of the larynx is fire in the airway. So-called “regular” endotracheal tubes can present some issues when performing microlaryngeal surgery with a laser. The PVC material on regular ETTs can be damaged with laser use, causing local damage of the mucosa at best, and a spectacular “blow-torch” like ignition effect if the laser punctures through the lumen of the ETT and comes into contact with oxygen-rich fresh gas. Lasers can also puncture an inflated cuff, further increasing the risk of airway fires. An indispensible tool in the arsenal of any anesthesiologist is the laser resistant endotracheal tube. This is especially the case in laser surgery of the airway. In fact, the ASA has released a practice advisory for the prevention of OR fires that recommends the use of laser resistant ETTs appropriate for the type of laser chosen for surgery. In addition, the ASA practice advisory also recommends that the tracheal cuff should be filled with saline rather than air and that the saline used to fill the cuff should be dyed with methylene blue. This allows immediate detection of laser damage to the cuff. The following describe some examples of laser resistant ETTs:
- Red rubber tubes like those manufactured by Sheridan work well with CO2 lasers and KTP lasers.
- Silicone based tubes wrapped in aluminum like the Xomed Laser shield II also work well with CO2 and KTP lasers. Its inflatable cuff is pre-dyed with methylene blue
- Stainless steel spiral ETTs like the Mallinkrodt Laser Flex tube work well with CO2 and KTP lasers, as well as offering a double-cuff design in case a laser damages one cuff
- Soft white rubber tubes wrapped in copper foil like the Rusch Lasertubus is resistant to Argon, Nd/YAG, and CO2 lasers as well as offering a double cuff design.