Fire in the operating room during tracheotomy: A case report

Veterans Affairs Medical Center, Minneapolis, MN, USA.
AANA journal 05/2005; 73(2):97-100.
Source: PubMed


We describe a patient who sustained facial burns during a tracheotomy. The electrosurgical unit indirectly started the fire during monitored anesthesia care when a high inspired oxygen concentration was being delivered to the patient by simple face mask. This case points out the need for prevention strategies, intraoperative vigilance, and quick intervention to prevent further patient injury any time the electrosurgical unit is used in an oxygen-enriched atmosphere.

Full-text preview

Available from:
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: DuraPrep is a widely used, alcohol-based surgical prep solution. The risk of surgical fire associated with incomplete drying of this agent in the context of electrosurgical procedures has been described previously. To date, there have been no reports of fire during tracheostomy associated with a flammable prep agent before entering the airway. We describe an operating room fire occurring during awake tracheostomy associated with the use of DuraPrep. A 62-year-old man with copious body hair underwent tracheostomy in the operating room. The neck was prepared with DuraPrep surgical solution, and after at least 3 minutes, the operative field was draped. Activation of electrocautery ignited a fire, and the patient was burned on his neck and shoulders. The fire was extinguished, and the patient recovered from both the tracheostomy and the burns. This case illustrates that DuraPrep should be avoided in the hirsute patient, because body hair interferes with drying of this solution and increases the risk of fire.
    Preview · Article · Jul 2006 · Head & Neck
  • [Show abstract] [Hide abstract]
    ABSTRACT: To report a patient who sustained a spark fire burn during a routine pterygium operation. A 40-year-old woman was referred for pterygium excision in her left eye. During the operation a low temperature cautery caused a spark fire that resulted in left eye corneal burn, upper and lower eyelid burns, and melting of eyelashes and eyebrows bilaterally. Topical antibiotics and vitamin C followed by topical corticosteroids were given. After 1 week the corneal epithelium healed but a paracentral corneal opacity developed. Two months later on last follow-up visit, a mild diffuse corneal opacity was still seen. The combination of three elements found in most routine (ophthalmologic) surgical fields-an enriched oxygen environment with the high temperature transmitted by the electrocautery in the vicinity of hair-might explain the event. Surgeons should try to separate these three elements or eliminate any of them, in order to minimize or prevent such events.
    No preview · Article · Jul 2008 · European journal of ophthalmology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: An abstract is unavailable. This article is available as HTML full text and PDF.
    Full-text · Article · Jun 2008 · Anesthesiology
Show more