In the present accident, we intubated the patient with a conventional PVC plastic tube. The tube was removed quickly when the ignition occurred. All common endotracheal tubes are potentially flammable, and so the risks of the various types of construction material have been well studied. A reusable red rubber tube and clear PVC plastic tube are resistant to laser irradiation in vitro. However, a thin coating of mucus or blood in vivo will absorb energy and cause ignition. 9 Silicone tubing is the most resistant to ignition. Furthermore, application of a protective metal foil wrap to the endotracheal tube and cuff has been recommended for the prevention of intratracheal fire. 9 However, it has also been reported that endobronchial fire resulting in endobronchial burn during Nd-YAG laser surgery occurred even when the tracheal tube was wrapped with metal tape. 6 Maximum possible distance should be maintained between the endotracheal tube and the surgical field. 6Figure 1 shows that the tracheal tube in the fire accident was kept at a sufficient distance from the surgical field. This accident indicates that ignition can occur from laser irradiation without direct impact to the tube. 5
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