Advancing field of medicine has introduced many new techniques and a plethora of instruments, one among them is laser. Lasers have been the up coming trend in ENT. Laser was introduced into medical field since 1956, however it’s Breidemeier in 1969 developed the coupler for CO2 laser to implement it to laryngeal micro surgery. Sharing the airway with the anesthetist and having a combustible gas passing next to the laser beam is like having a time bomb in your patient’s throat ready to ignite any moment. in was Norton and devos in 1978 who defuced the situation with the development of a flexible metal tube which is totally laser proof seen in figure 1 .

ET fire is a catastrophic disaster that may occur in laser assisted laryngeal surgery. Conventional ET tubes like PVC, red rubber, silicon rubber were used with protection. These ET tubes were protected by wrapping aluminium tape around the tube, placing neurosurgical cottonoids around the cuff, placing saline with in the cuff etc. However catastrophes did occur as they were not fool proof. We must bear in mind that these endotracheal tubes are made from highly combustible petroleum based plastics.

We use the laser flex tube meant for laser laryngeal surgeries. This is a flexible metallic tube made of stainless steel hose with a plastic segment at the distal end. It has 2 cuffs a proximal and a distal one as seen in figure 2. The proximal cuff shields the distal one from an inadvertent laser contact there by providing a tracheal seal. This tube has the unique advantage of having a laser resistant layer that is plurality of surface irregularities spaced with plurality in direction thus scattering the laser energy to a defocused beam. Hence makes laser assisted laryngeal surgery safe. We protect the cuff by placing a saline soaked cotton ball. Avoid prolonged exposure of laser to the steel hose. Care has to taken in the use of electrocautery as the tube would become an alternate active electrode.