Airway fires: reducing the risk during laser surgery.

In this issue, we evaluate two methods of providing safe, fire-resistant patient ventilation during laser surgery: ETTs marketed for use during laser surgery and wraps that can protect standard ETTs from laser energy under certain conditions. We evaluated five LRETTs from five manufacturers. The best protection from all types of laser energy to which we subjected the tubes - CO2, ND:YAG, and KTP - is offered by the Baxter Norton LRETT because it does not burn, although its use requires special ventilating techniques; it is rated Acceptable for all three types of laser surgery. Two other evaluated tubes provide protection from specific laser energies under limited conditions: the Bivona tube is rated Acceptable for CO2 laser surgery, and the Mallinckrodt tube is rated Acceptable for CO2 and KTP laser surgery. The Sheridan and Xomed tubes do not provide practical clinical protection and are rated Unacceptable. We also evaluated four wraps from three manufacturers. The Merocel wrap for standard ETTs, which is made of synthetic surgical sponge and adhesive-backed metal foil, is rated Acceptable and protects against typical surgical levels of CO2 and KTP laser energy. The Radio Shack metal sensing tape and 3M aluminum and copper foil tapes are rated Conditionally Acceptable for protecting against laser energy; they are Acceptable only on the condition that other means of laser protection are unavailable and alternative ventilation methods have been considered. These tapes are not marketed as laser-resistant wraps or FDA reviewed as medical devices; thus, users must assume full liability for a fire or any other adverse effects when using them. We recommend against using nonmedical metal tapes for most laser surgery on adults or larger pediatric patients since LRETTs or the Merocel wrap can be used for these applications. We further caution clinicians to base purchasing decisions for laser-resistant products on a thorough understanding of the issues behind our conclusions, which can be gained only by reading this evaluation in its entirety.