Laser resistant stainless steel endotracheal tube: Experimental and clinical evaluation

A fire due to endotracheal tube (ET) ignition is a catastrophic event that may occur during laser surgery of the upper airway, regardless of the wavelength utilized. Although methods exist that permit laser surgery without an ET, this is frequently not feasible. The current investigation was undertaken to evaluate the efficacy of a double‐cuffed stainless steel ET, first in the laboratory and subsequently in a clinical setting. Bench testing was performed using CO₂, (both standard and milliwatt) and KTP/532 lasers. Only the distal polyvinyl chloride cuffed end of the tube was potentially ignitable, however, the appropriate use of saline to fill the cuffs allowed only for cuff perforation without ignition. Canine testing was performed in 10 animals: 4 dogs were intubated from 3 to 4.5 hours with the laser resistant stainless steel endotracheal tube (LRSS‐ET) (Laser‐Flex Tracheal Tube; Mallinckrodt Anesthesia Products, St. Louis, MO) and 2 with an aluminum tape wrapped red rubber ET. Visual and histological examination were performed in both groups at 3 and 7 days. Four dogs underwent CO₂, laser laryngeal surgery with visual and histological examination performed at 7 days postoperatively. No untoward effects could be demonstrated due to the LRSS‐ET. A clinical study was then performed in 24 patients who underwent laser surgery of the upper aerodigestive tract with either a CO₂ or KTP/532 laser. In all cases ventilation was adequate, the shaft of the LRSS‐ET proved impervious to the laser, and the distal end of the tube protected the tracheobronchial tree safely. It is concluded that the LRSS‐ET is effective and safe in both CO₂ and KTP‐532 laser surgery of the upper airway when ET intubation is deemed necessary.