A Comparison of Laser-Protected Endotracheal Tubes

James A. Burns, Stephen D. Adlard, James B. Kobler, Monica A. Tynan, Robert H. Petrillo, Lauren F. Tracy*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Objectives: To compare the physical characteristics of 3 laser-protected endotracheal tubes (LPETs) commonly used in endoscopic laser surgery. To report potential intraoperative problems related to LPET use and suggest practical solutions. Study Design: Comparative analysis. Setting: Academic laboratory. Subjects and Methods: Physical characteristics of the Mallinckrodt Laser-Flex (MTL), Medtronic Laser-Shield II (ML-II), and Rusch LaserTubus (RL) were compared. The effect of bending LPETs on airflow resistance was estimated with a pressure transducer. The force required to pull each tube through the glottis and the pressure exerted during this maneuver were measured in a fresh cadaveric human larynx. Results: The design features and physical characteristics of LPETs differ, including varying balloon-tip lengths. Bending LPETs to acute angles caused significant pressure increase within the RL tube (Δ 3.42 cm H2O) and minimal change within the ML-II (Δ 0.12 cm H2O) and MTL (Δ 0.21 cm H2O) tubes. The average force required to pull the RL (48.12 g, P =.003) and MTL (282.4 g, P =.001) tubes through the glottis was 7.6× and 44.5× greater than that for the ML-II (6.39 g). When pulled through the vocal folds, the ML-II cuff exerted no detectable pressure, whereas higher pressures were measured for the RL (2.2 cm H2O) and MTL (6.5 cm H2O) tubes. Conclusion: The ML-II tube had the most favorable characteristics, with minimal pressure during extubation and resistance to kinking. The RL tube kinks readily with a resultant increase in resistance to airflow. The MTL tube extends farther into the trachea due to a relatively elongated balloon-tip configuration. Future LPET designs should incorporate features that avoid intraoperative difficulties related to airway protection and ventilation.

Original languageEnglish (US)
Pages (from-to)871-878
Number of pages8
JournalOtolaryngology - Head and Neck Surgery (United States)
Volume159
Issue number5
DOIs
StatePublished - Nov 1 2018

Keywords

  • endoscopic laryngeal laser surgery
  • endotracheal tube
  • intubation
  • laser
  • transoral laser surgery

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

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