Cost Savings of Using Fluorescein Strips in Laser Laryngoscopy

This technical report describes a simple, yet novel, approach to endotracheal cuff inflation in laryngological laser surgery that may result in significant cost savings for hospitals and patients. Pricing information was obtained from our tertiary care hospital's operating room pharmacy as of March 3, 2025. A common safety practice when using carbon dioxide (CO2) or potassium titanyl phosphate (KTP) lasers is to fill the endotracheal cuff balloon with normal saline and methylene blue. The cost of the smallest vial of methylene blue is $150.00, and the entire bottle must be discarded after each case. By using fluorescein strips, the cost of this safety measure can be reduced to $0.16. The option of using ophthalmic fluorescein strips is 0.11% of the cost of using methylene blue and effectively brings the cost close to zero. Therefore, by using fluorescein strips, laser laryngeal surgeries can realize a 99.89% savings in the balloon cuff component of the procedure. We propose using fluorescein dye in place of methylene blue for endotracheal cuffs in laser laryngeal surgeries. This change is easy to implement and may result in immediate, significant cost savings for both patients and hospitals.