General recommendations.
1. Work with all members of the team during the procedure to prevent an oxidizer-enriched atmosphere being placed near an ignition source.
2. Configure surgical drapes to minimize accumulation of oxygen and nitrous oxide underneath and prevent them from flowing into the surgical site.
3. Make sure flammable skin-prepping solutions are dry before draping.
4. Moisten gauze and sponges when they are used near an ignition source.
For high-risk procedures.
5. Notify the surgeon whenever an ignition source might placed near an oxidizer-enriched atmosphere or when an oxidizer concentration increases at the surgical site.
6. Assess any reduction in supplied oxygen to the patient by monitoring pulse oximetry and, if feasible, inspired, exhaled or delivered oxygen concentration.
For procedures with lasers (CO2, Nd:YAG, Ar, Er:YAG or KTP).
7. Use a laser-resistant tracheal tube that is resistant to the laser.
9. Fill the tracheal cuff of the laser tube with saline solution colored with an indicator dye such as methylene blue.
10. The surgeon should give adequate notice before activating the laser.
11. Reduce delivered oxygen concentration to the minimum necessary to avoid hypoxia.
12. Stop use of nitrous oxide.
13. Wait a few minutes after reducing the oxidizer-enriched atmosphere before approving activation of the laser.
For cases involving an ignition source and surgery inside the airway.
14. Use cuffed tracheal tubes when clinically appropriate.
15. Advise the surgeon against entering the trachea with an ignition source, such as an electrosurgery unit.
16. The surgeon should give adequate notice before activating an ignition source inside the airway.
11. Reduce delivered oxygen concentration to the minimum necessary to avoid hypoxia.
18. Stop the use of nitrous oxide.
19. Wait a few minutes after reducing the oxidizer-enriched atmosphere before approving the activation of the ignition source.
In cases such as surgery in the oropharynx.
20. Scavenging with suction may be used to reduce oxidizer enrichment in the operative field.
For cases involving moderate or deep sedation, an ignition source and surgery around the face, head, or neck.
21. Work with the surgeon to account for the level of sedation and the patient’s need for supplemental oxygen.
If moderate or deep sedation is used, or if the patient exhibits oxygen dependence.
22. Consider a sealed gas-delivery device such as a cuffed tracheal tube or laryngeal mask.
If moderate or deep sedation is not required and the patient does not exhibit oxygen-dependence.
23. Consider an open gas delivery device such as a facemask or nasal cannula.
24. The surgeon should give adequate notice before activating an ignition source around the face, head or neck.
25. Reduce delivered oxygen concentration to the minimum necessary to avoid hypoxia.
26. Wait a few minutes after reducing the oxidizer-enriched atmosphere before approving the activation of the ignition source.
From the report by the American Society of Anesthesiologists Task Force on Operating Room Fires in Anesthesiology 2008; 108:786 – 801. View the report on operating room fires (pdf).
