Lecture Notes: Operating Room Fire Prevention

Introduction

• Operating room fires are rare but devastating.
• Can be prevented by following recommendations.
• Key source: Anesthesia Patient Safety Foundation fire prevention algorithm.

Elements of Fire

• Three elements required:
  • Ignition source
  • Fuel source
  • Oxidizer
• Fire occurs when these elements combine.

Common Fire Zones

• Most fires occur during surgeries on the head, face, neck, and upper chest.
• Ignition sources are near the airway where oxygen or nitrous oxide may be used.

Primary Causes

• Use of 100% oxygen during sedation is a major cause.
• Prevention includes:
  • Limiting oxygen concentration.
  • Controlling the airway to prevent enriched oxygen near the surgical field.

Prevention Strategies

• Risk Assessment:

  • Conduct before every anesthetic.
  • Focus on high-risk procedures.

• Communication:

  • Between surgeon and anesthesia professional.
  • Agree on fire risk assessment and management plan.

• Skin Preparation:

  • Avoid pooling of alcohol-based preparations.
  • Allow adequate drying time.

Fire Risk Assessment

• High-Risk Procedures:

  • Head, neck, upper chest surgeries.
  • Proximity to airway and high oxidizer concentration.

• Oxygen Supplementation:

  • Assess need for oxygen above 30%.
  • Use devices to limit oxygen concentration if possible.

Management Techniques

• If high oxygen is needed:

  • Secure airway with endotracheal tube or supraglottic device.

• If airway devices are risky:

  • Use open draping to minimize oxygen accumulation.

Summary

• Open oxygen administration is a root cause of OR fires.
• Assign fire risk to every procedure.
• Collaborate with team to prevent oxidizer-enriched atmosphere.
• Maintain oxygen below 30% in high-risk cases.
• Allow skin preparations to dry before the procedure.
• Communicate with the surgeon about ignition sources.
• Use moistened gauzes and sponges near ignition sources.

Conclusion

• Understanding fire causes and management strategies is crucial.
• Collaboration between anesthesia personnel and OR staff is essential to prevent surgical fires.