Effects of the holmium:YAG and erbium:YAG lasers on endotracheal tubes.

Abstract

Endotracheal tube (ET) fire is the most frequent complication arising with laser surgery in the upper aerodigestive tract. No data are available about the safety of commonly used ETs when used with recently developed high-energy pulsed lasers, working with only a minimal thermal component but mainly photoablative. A comparative in vitro study was performed with three types of endotracheal tubes to assess their resistance to wall and cuff damage by the laser beams of two pulsed infrared solid-state lasers. ET perforation was attempted with the erbium:YAG (lambda = 2,930 nm) and holmium:YAG (lambda = 2,120 nm) lasers. For all experiments, a repetition rate of 5 Hz was used. The 2.5-microseconds holmium:YAG pulses were coupled into a nylon fibre of 400 microns diameter. The 2.0-microseconds erbium:YAG laser pulses were applied to ETs through a lens system providing a spot size diameter of 200 microns. Polyvinyl chloride and silicon ET segments were exposed to laser pulse energies from 97 to 500 mJ in the presence of different anaesthetic gas mixtures. The time from the onset of exposure to tube perforation was recorded. Thermal gradients following laser application were measured. Laser exposure was continued for up to 90 s, unless tube ignition occurred. At all energy levels tested, the photo-ablative mechanism of laser-tube interaction, with few thermal components, led to laser-induced tube ignition if an FiO2 > 21% for the holmium:YAG and 34% for the erbium:YAG laser was established. With increasing pulse energies, ET segments ignited sooner. MLT tubes performed best in the present safety test.