Avoidance of Laser Ignition of Endotracheal Tubes by Wrapping in Aluminium Foil Tape

Abstract

A 12-month-old child with a history of prematurity, severe respiratory compromise and failure to thrive required laser supraglottoplasty for severe laryngotracheobronchomalacia. Maintaining adequate oxygenation intraoperatively proved very difficult. Our usual technique with no endotracheal tube was not possible and CO 2 lasering was commenced with a polyvinylchloride endotracheal tube in the operative field. The endotracheal tube was struck by the laser but did not ignite. Concern about the very serious morbidity from a laser-induced fire in the airway prompted a search for possible solutions. No commercially available laser-resistant tube is available in small enough diameter to use in an infant. An aluminium foil tape (3M #425) was evaluated and found to be potentially very useful to protect against an airway fire in this uncommon situation.

Fire ignition during laser surgery in pet rodents

“…The mechanism of combustion is the initial penetration of the endotracheal tube by the laser and then the ignition of the tube. This is facilitated by the heat produced by the laser, the flow of oxygen, inflammable anesthetic agents or combustible materials [16,23,28]. We suppose that in the present cases the elements composing the “fire triangle” (oxidizer/inflammable substance/ignition source) [25] were: 100 per cent oxygen, sevoflurane or isoflurane and diode laser at 3–3.5 W continuous pulsation, respectively.…”

Tracheal foreign body after laser supraglottoplasty: A hidden but risky complication of an aluminum foil tape-wrapped endotracheal tube

“…Wrapping the ET is cumbersome and time-consuming, and variables exist in both the method of wrapping and the degree of tape adherence to the ET. Shortage in length or defect in the tape can make the ET vulnerable to ignition [12]. A thick tape does reduce ET flexibility and does increase the external diameter.…”

“…The rough edges of the tape are also potentially hazardous to the larynx and trachea. Manually scratching the foil tape, as suggested by Walker et al [12] to make it more matte and able to disperse the laser beam in all directions may also weaken and roughen the tape, therefore impairing its ability to tightly adhere well to the ET. Pieces of the loose adhered tape may be easily torn off during dynamic respiratory motion and surgical manipulation and retained in airway become a potential dangerous foreign body.…”

“…The most effective and commonly used method in clinical practice involves wrapping the ET with a thin aluminum foil tape; its reflective surface can protect the ET from the laser beam [10][11][12][13]. However, this wrapped ET also poses potential risks [14].…”

Anesthetic management of an unusual complication during laser ablation of congenital subglottic hemangioma

“…Self-adhesive, non-reflective aluminum tape may be used to protect endotracheal tubes,[3] but it increases the outer diameter of the tube, compelling the use of smaller inner diameter tubes. Laser-resistant tracheostomy tubes are not available.…”