A Comparison of Laser-Protected Endotracheal Tubes. (November 2018)

• Record Type: Journal Article
• Authors: Burns, James A.; Adlard, Stephen D.; Kobler, James B.; Tynan, Monica A.; Petrillo, Robert H.; Tracy, Lauren F.
• Is Part Of: Otolaryngology--head and neck surgery. Volume 159:Number 5(2018)
• Page Start: 871
• Page End: 878
• Publication Date: 2018-11
• Subjects: laser -- endotracheal tube -- intubation -- endoscopic laryngeal laser surgery -- transoral laser surgery; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599818796106
• Languages: English
• ISSNs: 0194-5998

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 H2 O) and minimal change within the ML-II (Δ 0.12 cm H2 O) and MTL (Δ 0.21 cm H2 O) 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 H2 O) and MTL (6.5 cm H2 O) 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.