Clifford Gevirtz, MD, is employed by RAA of New York and practices anesthesiology throughout New York and Long Island, N.Y. RAA is managed by Somnia Anesthesia.
Q: What are the primary causes of operating room fires?
Dr. Clifford Gevirtz: You need three things in order for a fire to occur: A source of fuel (e.g. drapes, prepping agents), an oxidizer (supplemental oxygen or nitrous oxide) and finally an ignition source (electrocautery devices, lasers, drills and burrs, argon beam coagulators, fiberoptic light cables, defibrillator paddles).
With respect to prepping agents, some have a small amount of alcohol, which provides a source of fuel. This is why it so very important to let the prep thoroughly dry before starting. The drapes, which may be made of flammable material, can also serve as a source of fuel. Other materials have also been reported: sponges; drapes; gauze; nasal cannulae; the patient's hair; dressings; ointments; gowns; gastrointestinal tract gases; blankets; suction catheters; flexible endoscopes; fiberoptic cable coverings; gloves; and packaging materials.
Supplemental oxygen provided by nasal cannulae can be especially dangerous in that oxygen may accumulate under drapes and the plastic of the cannula itself may act as a source of fuel. Most anesthesiologists and nurse anesthetists use supplemental oxygen almost as a routine during sedation, but published studies comparing supplemental oxygen and compressed air during cataract surgery showed no difference in oxygen saturation. Another possibility is to use oxygen intermittently so that there is minimal build up (i.e., turn it off whenever there is electrocautery being used and then turn it back on only if needed).
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Q: There have been several recent reports of surgical fires. Is there a growing trend?
CG: While there is no national registry of OR fires, ECRI Institute has been following this issue closely. Much can be done to reduce this problem including simple things like using the oxygen only when really necessary.
Q: What else should organizations do?
CG: Anesthesiologists should periodically participate in OR fire drills with the entire OR team. This formal rehearsal should take place during dedicated educational time, not during patient care. ASC managers should make sure that there are periodic drills regarding OR fires. They can also conduct an audit of anesthesia charts to see if oxygen is being used needlessly during MAC cases.
The anesthesiologist should have a continuing dialogue with all members of the procedure team throughout the procedure. The key issue is to have an awareness of what the surgeon is doing with the cautery or the laser and to remember to turn off the supplemental oxygen when not needed. Use the pulse oximeter to guide whether supplemental oxygen is even needed.
Learn more about Somnia Anesthesia.
Related Articles on OR Fires:
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Staff Education Tool: Extinguishing a Surgical Fire Poster
Patient Safety Tool: Surgical Fire Prevention Poster
