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During many surgeries, the risks of fire exist because heat sources (e.g., electrosurgical probes, lasers) are used close to fuels (e.g., tracheal tubes, body hair, surgical drapes) in oxygen-enriched atmospheres (OEA). When the OEA is recognized as a hazard, precautions are taken to reduce the risk, e.g., minimizing oxygen concentration prior to use of electrosurgery.
However, some actions of the surgical team can lead to one of two types of OEAs that are not readily recognized by, or apparent to, the surgical team as a hazard. One type involves entering a body cavity that contains an OEA, during tracheostomy for example.The other type has an OEA developing around the surgical site as can happen when a misplaced or leaking breathing circuit is under the surgical drapes. With regrettable frequency in these cases, a surgical fire results.
This paper discusses several cases of fire during surgery that involved insidious oxygen-enriched atmospheres. Recommendations to prevent and to deal with such fires are also presented.
anesthesia, electrosurgery, oxygen, precautions, pulse oximetry surgical fires surgery
de Richemond, AL
senior project engineer with ECRI, PA
director of the accident and forensic investigations group for ECRI, PA