Fires of endotracheal tubes of three different materials during carbon dioxide laser surgery

The hazards of fire during CO2 laser surgery of the airway necessitate the use of special endotracheal tubes. We reviewed 227 cases receiving CO2 laser laryngeal surgery over the past 7 years, of whom 3 suffered the complications as a result of endotracheal fire. Tracheal tubes made of different materials were used among them, including silicone T-tube (Montgomery Safe-T-tube), jet ventilation tube and Xomed laser shield endotracheal tube. In addition, we tested in vitro the combustibility of endotracheal tubes of six different materials which included silicone T-tube, jet ventilation tube, Xomed laser shield endotracheal tube, stainless Laser-Flex tracheal tube, polyvinyl chloride (PVC) endotracheal tube and aluminum foil wrapped PVC endotracheal tube by exposing them to continuous operating CO2 laser in room air. The time to initiation of fire and burn through the lumen was 0.3 second for T-tube, 0.5 s for jet ventilation tube, 5 s for Xomed laser shield endotracheal tube, and 0.8 s for PVC endotracheal tube, respectively. The Laser-Flex tracheal tube (stainless) and aluminum foil wrapped PVC endotracheal tube did not catch fire after 30 s of CO2 laser irradiation. The silicone T-tube seemed to be the most dangerous. Jet ventilation tube and Xomed laser shield endotracheal tube have the risk of fire. Aluminum foil wrapped PVC endotracheal tube was reported to catch fire before. Therefore we are of the opinion that the stainless endotracheal tube is the safest tube during CO2 laser surgery.