title: Surgical fires in laser laryngeal surgery: are we safe enough?
abstract: OBJECTIVE
  Laser surgery of the larynx and airway remains high risk for the formation of operating room fire. Traditional methods of fire prevention have included use of "laser safe" tubes, inflation of a protective cuff with saline, and wet pledgets to protect the endotracheal tube from laser strikes. We tested a mechanical model of laser laryngeal surgery to evaluate the fire risk.
  
  
  METHODS
  Mechanical model.
  
  
  METHODS
  Laboratory.
  
  
  METHODS
  An intubation mannequin was positioned for suspension microlaryngoscopy. A Laser-Shield II cuffed endotracheal tube was placed through the larynx and the cuff inflated using saline. Wet pledgets covered the inflated cuff. A CO2 laser created an inadvertent cuff strike at varying oxygen concentrations. Risk reduction measures were implemented to discern any notable change in the outcome after fire.
  
  
  RESULTS
  At 100% FiO2 an immediate fire with sustained flame was created and at 40% FiO2 a near immediate sustained flame was created. At 29% FiO2, a small nonsustained flame was noted. At room air, no fire was created. There was no discernible difference in the severity of laryngeal damage after the fire occurred whether the tube was immediately pulled from the mannequin or if saline was poured down the airway as a first response.
  
  
  CONCLUSIONS
  While "laser safe" tubes provide a layer of protection against fires, they are not fire proof. Inadvertent cuff perforation may result in fire formation in low-level oxygen enriched environments. Placement of wet pledgets do not provide absolute protection. Endotracheal tube (ETT) cuffs should be placed distally well away from an inadvertent laser strike while maintaining the minimum supplemental oxygen necessary.
authors.affiliation: Pediatric Otolaryngology, The University of Texas Health Science Center at Houston, Medical School, Department of Otorhinolaryngology-Head & Neck Surgery, Houston, Texas, USA Soham.Roy@uth.tmc.edu.
authors.forename: Soham
authors.initials: S
authors.lastname: Roy
authors.affiliation: Hofstra North Shore-LIJ School of Medicine, Chief of Pediatric Otolaryngology, Cohen Children's Medical Center, Long Island, New York, USA.
authors.forename: Lee P
authors.initials: LP
authors.lastname: Smith
mesh_terms: D005390:Fires; D007442:Intubation, Intratracheal; D007830:Larynx / Q000601:surgery*; D053685:Laser Therapy; D008348:Manikins; D010100:Oxygen; D061214:Patient Safety; D018570:Risk Assessment
chemical_list: D010100:Oxygen
keywords: fire; laryngeal surgery; laser; safety