Health Devices. 1990 Apr;19(4):109-39.
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.
在本期中，我们评估了两种在激光手术期间提供安全、防火的患者通气方法：用于激光手术的市售气管内导管（ETT）以及在特定条件下可保护标准ETT免受激光能量影响的包裹物。我们评估了来自五个制造商的五种激光抗性气管内导管（LRETT）。百特诺顿LRETT对我们测试的所有类型激光能量（二氧化碳、钕：钇铝石榴石和磷酸钛钾）提供了最佳防护，因为它不会燃烧，尽管其使用需要特殊的通气技术；它在所有三种类型的激光手术中评级为“可接受”。另外两种评估的导管在有限条件下对特定激光能量提供防护：比沃纳导管在二氧化碳激光手术中评级为“可接受”，而马利克罗斯特导管在二氧化碳和磷酸钛钾激光手术中评级为“可接受”。谢里丹和索迈德导管未提供实际临床防护，评级为“不可接受”。我们还评估了来自三个制造商的四种包裹物。用于标准ETT的美罗赛尔包裹物由合成手术海绵和带粘性的金属箔制成，评级为“可接受”，可防护典型手术水平的二氧化碳和磷酸钛钾激光能量。无线电 Shack金属感应胶带以及3M铝箔和铜箔胶带在防护激光能量方面评级为“有条件可接受”；仅在没有其他激光防护手段且已考虑替代通气方法的条件下它们才是“可接受”的。这些胶带并非作为抗激光包裹物销售也未经过FDA作为医疗器械进行审查；因此，使用者在使用它们时必须对火灾或任何其他不良影响承担全部责任。对于大多数针对成人或较大儿科患者的激光手术，我们不建议使用非医用金属胶带，因为LRETT或美罗赛尔包裹物可用于这些情况。我们进一步告诫临床医生，在对激光抗性产品做出购买决策时，要基于对我们结论背后问题的透彻理解，而这只有通过完整阅读本评估才能获得。
