Thank you. Operating room fires are rare but potentially devastating events that fortunately can be prevented by following well-established recommendations. Every member of the surgical team should be educated and trained to follow the principles of operating room fire prevention. This video explores the key elements of the current recommendations based upon the Anesthesia Patient Safety Foundation fire prevention algorithm.
Fires require three elements, an ignition source, a fuel source, and an oxidizer. A fire can occur when all three elements merge in the right combination. In the operating room, ignition sources, fuel sources, and oxidizers abound.
Most operating room fires occur during surgeries involving the head, face, neck and upper chest. Surgery in these areas brings ignition sources close to the patient's airway, where oxidizers like oxygen or nitrous oxide may be in use. The common practice of using a source of 100% oxygen during sedation with a natural airway is the root cause of the majority of serious operating room fires. Limiting the delivered oxygen concentration or controlling the airway to keep enriched oxygen oxygen out of the surgical field are fundamental prevention strategies. For procedures in the airway, always consider limiting the concentration of oxygen to less than 30% and avoiding nitrous oxide even while using an endotracheal tube.
Preventing operating room fires requires a thorough risk assessment before every anesthetic and careful management in high-risk procedures. Communication between the surgeon and anesthesia professional during the pre-procedure timeout and throughout the procedure is required. to agree on the fire risk assessment as well as confirm the use of any heat sources and the plan for managing oxidizers.
In all cases, nurses and surgeons must avoid pooling of alcohol-based skin preparations and allow adequate drying time. The first question to ask during the risk assessment should be, is the patient at risk for surgical fire? Procedures involving the head, neck, and upper chest, where an ignition source is used, are considered high risk for a surgical fire due to the proximity of the airway and potential for a high concentration of oxidizer. If the patient is not at risk, proceed, but frequently reassess the changes in fire risk. If, on the other hand, the patient is at high risk, one must ask, does the patient require oxygen supplementation?
If the answer is no, allow the patient to breathe room air. However, if the patient requires oxygen supplementation, is an oxygen concentration greater than 30% required to maintain an adequate oxygen saturation? If not, use a delivery device such as a blender or common gas outlet to maintain an oxygen concentration below 30%. If at the last minute, delivered oxygen concentration greater than 30% is required to maintain adequate oxygenation, secure the airway with an endotracheal tube or a supraglottic airway device.
Although securing the airway is the preferred method for preventing fires, for risk of cases where using an airway device creates an undue risk or is not feasible, oxygen accumulation in the surgical field may be minimized by open draping to provide wide exposure of the surgical field to the atmosphere. In summary, open administration of enriched oxygen is the root cause in the majority of serious OR fires. Assign a fire risk to every procedure and identify situations that are high risk for fire.
Work with all members of the team throughout the procedure to minimize the presence of an oxidizer enriched atmosphere in proximity to an ignition source. Manage delivered oxygen to less than 30% in high-risk situations. In rare cases where controlling the airway has an acceptable risk, configure surgical drapes to minimize the accumulation of oxygen and nitrous oxide and prevent these oxidizers from flowing into the surgical site.
Control the airway with an endotracheal tube or supraglottic airway device if the delivered oxygen concentration cannot be maintained below 30%. Always allow skin preparation solutions to dry. Communicate with the surgeon whenever an ignition source might be used near an oxidizer-enriched atmosphere, or when there is a potential increase in oxidizer concentration at the surgical site.
Moisten gauzes and sponges used near an ignition source. By understanding the causes of fire and implementing recommended management strategies, anesthesia personnel and operating room staff can work collaboratively to prevent surgical fires.