Anesthesiology Group Issues Advisory on Operating Room Fires

While the occurrence may be relatively rare, the effects of operating room fires can be devastating. The American Society of Anesthesiologists estimates that such fires occur 50 to 100 times in ORs throughout the United States each year but notes that, without a national reporting system for OR fires, it is hard to gauge the exact number. Considering even one OR fire too many, however, an ASA task force has issued a Practice Advisory calling for focused education and preparation aimed at identifying situations conducive to fire, preventing the occurrence of OR fires, reducing adverse outcomes associated with OR fires, and responding to them effectively.

Featured in the May issue of the journal Anesthesiology, the advisory notes that for a fire to occur, three components or a "fire triad" must be present in the OR: an oxidizer, an ignition source, and a fuel. In the fire triad, oxidizers include oxygen and nitrous oxide; ignition sources include lasers, drills, and electrosurgery units; and fuels include tracheal tubes, sponges, and drapes. The advisory says anesthesiologists should have fire safety education specific to OR fires and participate in OR fire drills with the entire OR team.

Before each surgical case, the entire OR team must determine if a case is at high risk for surgical fires, the advisory says. If a high-risk situation exists the team must decide on a plan and roles for preventing and managing a fire. And in every OR where a fire triad can exist, a protocol for the prevention and management of fires should be displayed. Other key recommendations from the advisory in the realm of prevention include:

  • Avoid using ignition sources in proximity to an oxidizer-enriched atmosphere.
  • Configure surgical drapes to minimize the accumulation of oxidizers.
  • Allow sufficient drying time for flammable skin prepping solutions.
  • Moisten sponges and gauze when used in proximity to ignition sources.
  • The anesthesiologist should collaborate with all surgical team members throughout the procedure to minimize the presence of an oxidizer-enriched atmosphere in proximity to an ignition source.
  • During high risk procedures in which an ignition source is to be used in an oxidizer-enriched atmosphere, before the ignition source is activated:
    -- Announce the intent to use the source.
    -- Reduce the delivered oxygen concentration to the minimum required to avoid hypoxia.
    -- Stop the use of nitrous oxide.

The advisory also details recommendations for fire prevention and management in high risk procedures, laser procedures, surgery inside the airway, for cases involving moderate or deep sedation, and surgery around the face. For more information on the "Practice Advisory for the Prevention and Management of Operating Room Fires," visit the Anesthesiology Web site at www.anesthesiology.org and the ASA Web site at www.asahq.org.

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