Iatrogenic burns in the operating room (OR) are relatively rare events, but the consequences can be dramatic and devastating. Nearly all are preventable. Although the use of modern nonflammable inhalation anesthetic gases has lowered the severity of fire occurrence, many anesthesiologists today are less aware of how to properly prevent and manage OR fires. Any fire that occurs on/in the proximity of patients undergoing surgery is considered an OR fire. Surgical fires occur directly on/in a patient, while airway fires specifically occur in the patient’s airway. Sources of iatrogenic burns are primarily thermal in nature and include warming devices, OR lights, high-powered light cables, electrocautery devices, lasers, heated probes, and hot retractors.
INCIDENCE AND ADVERSE OUTCOMES
Although impossible to estimate with complete accuracy, approximately 600 surgical fires are thought to occur each year (a comparable incidence to that of wrong-site surgery). In a recent closed claims analysis, 103 OR fire claims were identified, with electrocautery serving as the ignition source in 90% of the claims. Electrocautery-induced fires are increasing, growing from less than 1% of all surgical claims between 1985 and 1994 to 4.4% between 2000 and 2009. Oxygen was identified as the oxidizer source in 95% of electrocautery-induced fires. The majority of electrocautery-induced fires occurred during monitored anesthesia care (MAC), with an especially high incidence during plastic surgery on the face. A much smaller percentage of fires occurred during general anesthesia cases, particularly during high-risk cases like tonsillectomy and tracheostomy. Lasers are a growing source of OR fires.
Several patient deaths occur each year due to OR fires. However, the severity of injury is on average less than other surgical claims. Payments are more often made in fire claims than other surgical claims, but the payments are on average lower for fire claims (median $120 166). Other adverse outcomes include minor and major burns, inhalation injuries, psychological trauma, increased hospitalization costs, and liability.
A 1994 closed claims analysis of burns from warming devices found 28 cases. Warmed IV solution bags or plastic bottles accounted for 64% of claims and electrically powered warming devices (particularly, circulating water blankets) made up 29% of claims. Of the other identifiable thermal burn claims, electrocautery devices and hot retractors were largely responsible. More recently, there are case reports of burns from forced-air warming devices, fires originating from anesthesia machines, OR lights, povidone-iodine, and isopropyl alcohol pooling on heating pads, and residual disinfectant on a TEE probe. Constant assessment of the patient and potential malfunctioning equipment is the cornerstone for preventing and minimizing severity of these types of burns.
COMPONENTS OF AN OPERATING ROOM FIRE
Three components within a “fire triad” are necessary for an OR fire: (1) an oxidizer, (2) an ignition source, and (3) fuel. All three components must be present in sufficient proportions for a fire to occur. Oxidizers lower the ...