Liability of laryngeal mask airway devices to thermal damage from KTP and Nd : YAG lasers

We have compared the liability of four laryngeal mask airway (LMA) devices (standard, flexible, intubating and reusable) and a tracheal tube to therma l damage from KTP and Nd:YAG lasers at two power densities used commonly in airway surgery: 570 W cm(-2) and 1140 W cm(-2) Eighty-five airway devices were tested: 24 standard LMA (silicone-based), 12 flexible LMA (silicone-ba sed, metal wires), 24 disposable LMA (PVC-based), one intubating LMA (silic one and steel-based) and 24 PVC-based tracheal tubes. Comparisons were made during laser strike to eight different targets: the unmarked and marked pa rt of the airway device tube; the unmarked part of the airway device tube a fter application of blood; the cuff filled with air or methylene blue dye; the unmarked flexible LMA tube on or between the metal wires; and the epigl ottic elevator bar of the intubating LMA. The laser strike was continued fo r 30 s and each target was tested three times. Three different, but identic al, impact sites were used for each target. There was no ignition of any ai rway device with either power density or laser type. The silicone-based LMA were generally more resistant to flaring and penetration than the PVC-base d LMA and tracheal tube, but the intubating LMA tube flared more rapidly wi th the KTP laser, and the disposable LMA cuff was more resistant to penetra tion. Print markings, blood and the metal wires of the flexible LMA reduced the thermal resistance of the tube. Filling the cuff with methylene blue d ye increased the thermal resistance of all airway devices. We conclude that the silicone-based LMA devices were more thermal resistant to KTP and Nd:Y AG laser strike than PVC-based devices with the exception of the disposable LMA cuff and the intubating LMA tube.