Operating Room Fires: Prevention and Management

Introduction

• Operating room fires are rare but serious events.
• Prevention is possible by adhering to established guidelines.
• All surgical team members should be trained in fire prevention.
• Based on Anesthesia Patient Safety Foundation Fire Prevention Algorithm.

Fire Triangle: Key Elements

• Ignition Source
• Fuel Source
• Oxidizer
• Fires occur when all three elements combine.

Common Scenarios

• Most fires occur during surgeries of the head, face, neck, and upper chest.
• These areas are close to the airway where oxidizers like oxygen/nitrous oxide may be present.

Prevention Strategies

• Limit Oxygen Concentration: Aim for less than 30% oxygen concentration.
• Control Airway: Use techniques to keep enriched oxygen out of the surgical field.
• Avoid Nitrous Oxide when possible.

Risk Assessment

• Conduct thorough risk assessment before each anesthetic.
• Communicate between surgeons and anesthesia professionals.
• Agree on fire risk assessment and oxidizer plans.

High-Risk Procedures

• Procedures involving head, neck, upper chest with ignition sources.
• Assess if the patient is at risk for surgical fire.

Management of Oxygen Levels

• Ask if oxygen supplementation is necessary.
• If no supplementation needed: Allow breathing room air.
• If oxygen needed: Keep concentration below 30% with devices like blenders.
• If >30% oxygen required: Secure airway with endotracheal tube or supraglottic device.

Alternative Strategies

• In rare cases where airway control is risky, minimize oxygen in the surgical field through open draping.

Summary of Key Points

• Open administration of enriched oxygen is the main cause of OR fires.
• Assign fire risk to every procedure.
• Minimize oxidizer presence near ignition sources.
• Keep oxygen levels <30% during high-risk situations.
• When airway control is risky, configure drapes to lower oxygen accumulation.
• Ensure skin prep solutions dry properly.
• Maintain communication regarding ignition sources and oxidizer levels.

Additional Safety Measures

• Moisten gauze/sponges near ignition sources.
• Collaborative effort by anesthesia staff and OR team to prevent fires.