Endotracheal Tube Ignition During Laser Surgery of the Larynx

Value of endotracheal tube safety in laryngeal laser surgery

“…Since the implementation of CO 2 laser surgery of the larynx about 30 years ago [1] there has been a lively discussion concerning a variety of complications and their precautions. As one of the first Snow in 1976 [3] and Burgess in 1979 [2] reported the ignition of an ETT, the most dangerous and life threatening complication of endolaryngeal CO 2 laser surgery. In literature, 11 case reports concerning ETT fires as a complication of CO 2 laser surgery could be found.…”

“…Initially some authors focused on wrapping the tube with thin metal foils [4,[9][10][11][12][13][14] as a safety precaution, which should protect the shafts from direct, continuous high power CO 2 laser radiation. On the other hand there have been reports on tube fires or explosions, even in wrapped tubes, for example, when the laser beam first heats, then melts, and finally ignites the ETT [2,15,16]. Other side effects of metal foils are, that their surfaces are often highly reflective and that occasionally the metal tape becomes loose and its edges may cut the surrounding tissues [17].…”

“…Furthermore, the O 2 -saturation of the narcotic gases plays an important role in the safety of CO 2 laser surgery of the upper aerodigestive tract. Recent investigations could demonstrate that high levels of oxygen during laser surgery could promote the flammability of the inspired gases and thus the ignition of ETTs [2,11,16,26,[31][32][33]. This phenomenon could easily occur especially at the end of operations when the patient receives an oxygen-enriched mixture of anesthetic gases.…”

“…They also pointed out that the ETT could easily be ignited in the presence of a high oxygen saturation. Seven years later Burgess and LeJeune [2] were the first to report on a case of ETT ignition which occurred during laser surgery of the larynx in a 6-year-old girl.…”

Airflow through the auxiliary line of the laser fiber prevents ignition of intra‐airway fire during endoscopic laser surgery

“…When the irradiation point is adjacent to the tracheal tube, and the tracheal tube is exposed to the laser, it ignites easily. Therefore, many studies on the ignition of the tubes have been carried out [11][12][13][14][15]. However, in cases in which the laser irradiation point is far from the tracheal tube, it is unlikely that the tracheal tube can be an ignition site because the laser output decreases in power in proportion with the distance.…”