Safe Use of Flammable Endotracheal Tubes During Anesthesia for Laryngeal Laser Surgery-Report of 1024 Cases and a Brief Literature Review

Document Type : Original


1 Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran.

2 Department of Otolaryngology, Iran University of Medical Sciences, Tehran, Iran.


One of the major concerns in laryngeal laser surgery is the risk of airway fire. The introduction ofwrapped tubes and metal tubes has reduced the fire hazards. However, these tubes are expensive and do not provide convenient access to the surgical field. There are few laboratory studies addressing the resistance of polyvinylchloride tubes against ignition in the given circumstances. Nevertheless, its safety should be approved in clinical practices.
Materials and Methods:
This  retrospective studyevaluated the airway management on 1024 patients undergoing laryngeal laser surgery. The data collection included the information about the type of endotracheal tube (ETT), mode of ventilation, and airway hazards (e.g., tube ignition).
Polyvinylchloride tubes and conventional positive pressure ventilation was applied for most of the patients (84.1%). The tube cuff was pierced with laser beam in 22 cases (2.5%). However, there was no case of ETT ignition or airway fire.
Polyvinylchloride tubes can be safely used in this subset of surgeries pending meticulous attention to the safety recommendations.


Main Subjects

1. Yan YOlszewski AEHoffman MRZhuang PFord CNDailey SHet al. Use of lasers in laryngeal surgery. J Voice. 2010 Jan;24(1):102-9.
2. Straub HW. Protection of the humaneyefromlaser  radiation. Ann N Y Acad Sci. 1965 May 28;122:773-6.
3. Chinn SD. Complications of laser surgery: safety, risks, and the plume. Clin Podiatr Med Surg. 1992 Jul;9(3):
4. Sheinbein DS, Loeb RG. Laser surgery and fire hazards in ear, nose, and throat surgeries.Anesthesiol Clin. 2010 Sep;28(3):485-96.
5. Li SChen LTan F. Laryngeal surgery using a CO2 laser: is a polyvinylchloride endotracheal tube safe? Am J Otolaryngol. 2012 Nov-Dec;33(6):714-7.
7. Haas CFEakin RMKonkle MABlank R. Endotracheal tubes: old and new. Respir Care. 2014 Jun; 59(6): 933-52; discussion 952-5.
8. Rontal ERontal MWenokur ME. Jet insufflations anesthesia for endolaryngeal  laser surgery:  a review of 318 consecutive cases. Laryngoscope.1985 Aug; 95(8): 990-2.
9. Hunsaker DH. Anesthesia for microlaryngeal surgery: the case for subglottic jet ventilation. Laryngoscope. 1994 Aug;104(8 Pt 2 Suppl 65):1-30.
10. Werawatganon T, Supiyaphun P, Kerekhanjanarong V, Rodanant O, Sirichotewithayakorn  P. Intermittent apnea and total intravenous anesthesia for microscopic laryngeal surgery.J Med Assoc Thai.2004  May;87(5):547-50.
11. Keon TP. Anesthetic management during laser surgery. Int Anesthesiol Clin.1992 Fall;30(4):99-107.
12. Anand VKHerbert JRobbett WFZelman WH. Safe anesthesia for endoscopic laryngeal laser surgery. Lasers Surg Med. 1987;7(3):275-7.