Complications of CO2 laser surgery of the larynx

Since the introduction of CO2 laser surgery, surgeons have stressed the importance of protecting nontarget structures from errant irradiation. Although striking areas outside the intended field may inflict little or no damage, irradiating an exposed endotracheal tube may result in an endotracheal fire. Recent experience with a case of endotracheal tube ignition led to reevaluation of those factors associated with this serious complication. In an attempt to determine the best endotracheal tube to use during laser surgery of the larynx, the flammability of polyvinyl chloride and red rubber endotracheal tubes was compared. Several factors were noted to contribute to the potential hazard of endotracheal tube ignition. Since red rubber tubes are less flammable, they should be used during laryngeal CO2 laser surgery.