• P Heine.
• Klinik für Anaesthesiologie und Operative Intensivmedizin, Klinikum Steglitz der Freien Universität Berlin.
• Anaesthesist. 1989 Aug 1; 38 (8): 434-6.

AbstractVarious measures have been taken to minimize laser-specific hazards during laryngotracheal microsurgery with CO2-laser equipment. Endorsing Norton's view that only a metal tube ensures complete safety during laser surgery, we tested the "Laser-Flex", a new endotracheal tube (ETT) of high-grade stainless steel. This reconstructed, flexible, gas-tight ETT was designed to avoid perforation and even ignition of the tube with consecutive inhalation of combustion products known to be very strong lung irritants. The dull surface of the spiral ETT prevents damage to the surrounding mucosa by diverging the laser beam. The flexibility and greater stability compared with PVC- or silicone armored tubes makes intubation possible without a guide even under difficult conditions. A small PVC-tube with two high-volume-low-pressure cuffs is attached to the distal end of the metal ETT. The cuffs are filled via different inlets clearly distinguished by color as well as by the inscriptions "proximal" and "distal". Both inlet lines float inside the metal tube, thus being protected from accidental laser beams. The cuffs are filled with saline solution. In case of inflammation and destruction of the proximal cuff, the discharged solution will extinguish the flame and also protect the distal cuff, ensuring normal ventilation. Thus none of the laser operations had to be interrupted during our test period if accidentally perforation of the proximal cuff occurred. The high price of the "Laser-Flex" should not be a reason to abstain from using this tube. In view of the higher margin of patient safety, this tube might be used even from an economic point of view. In our tests we reused each tube five to eight times, thus lowering the costs with each reuse. Checks following sterilization after each use did not show any dysfunction of the cuffs or valves.

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