Liability of laryngeal mask airway devices to thermal damage from KTP and Nd:YAG lasers

Abstract

We have compared the liability of four laryngeal mask airway (LMA) devices (standard, flexible, intubating and reusable) and a tracheal tube to thermal damage from KTP and Nd:YAG lasers at two power densities used commonly in airway surgery: 570 W cm-2 and 1140 W cm-2. Eighty-five airway devices were tested: 24 standard LMA (silicone-based), 12 flexible LMA (silicone-based, metal wires), 24 disposable LMA (PVC-based), one intubating LMA (silicone and steel-based) and 24 PVC-based tracheal tubes. Comparisons were made during laser strike to eight different targets: the unmarked and marked part of the airway device tube; the unmarked part of the airway device tube after application of blood; the cuff filled with air or methylene blue dye; the unmarked flexible LMA tube on or between the metal wires; and the epiglottic elevator bar of the intubating LMA. The laser strike was continued for 30 s and each target was tested three times. Three different, but identical, impact sites were used for each target. There was no ignition of any airway device with either power density or laser type. The silicone-based LMA were generally more resistant to flaring and penetration than the PVC-based LMA and tracheal tube, but the intubating LMA tube flared more rapidly with the KTP laser, and the disposable LMA cuff was more resistant to penetration. Print markings, blood and the metal wires of the flexible LMA reduced the thermal resistance of the tube. Filling the cuff with methylene blue dye increased the thermal resistance of all airway devices. We conclude that the silicone-based LMA devices were more thermal resistant to KTP and Nd:YAG laser strike than PVC-based devices with the exception of the disposable LMA cuff and the intubating LMA tube.