Electrocautery-Induced Airway Fire During Tracheostomy

Intra‐oral ignition of monopolar diathermy during transnasal humidified rapid‐insufflation ventilatory exchange (THRIVE)

“…with diathermy coming into contact with 100% oxygen in the airway [2,3,7]. The type of monopolar diathermy does not seem to matter, with cases reported where cutting, coagulation or blend modes were used [8].…”

“…Airway fires appear to be less common when diathermy is used. However, the ASA Practice Advisory on operating room fires [1] lists electrosurgical or electrocautery devices as possible ignition sources, based on tracheostomy case reports in the literature [2,3]. The incidence of diathermyrelated airway fire has not been quantified and there have been no reports of fires occurring during transnasal humidified rapid-insufflation ventilatory exchange (THRIVE).…”

Airway fire due to diathermy during tracheostomy in an intensive care patient

“…These patients have an increased incidence of mortality and morbidity in larger studies of surgical tracheostomy [1,13]. High oxygen requirements [3,5,6], routine preoxygenation prior to changing the tracheal tubes [2,4,7] and supplementary nitrous oxide [9] were the usual oxidising sources. In several cases [4,6,7], including the one reported here and the case that resulted in a fatality [5], the tracheal incision was intentionally made using the diathermy, either in the cutting or coagulation mode.…”

“…In several cases [4,6,7], including the one reported here and the case that resulted in a fatality [5], the tracheal incision was intentionally made using the diathermy, either in the cutting or coagulation mode. However, in other cases [2,3], the tracheal incision was made with a scalpel and the tracheal tube was ignited by the diathermy while securing haemostasis. In most of the cases [2±7], ignition was started by cuff de¯ation causing a Case reports Anaesthesia, 2001, 56, 441±446 ................................................................................................................................................................................................................................................ …”

“…However, some authors still recommend the routine use of high oxygen concentrations [2]. Combining oxygen with a non-¯ammable carrier gas, such as nitrogen or helium, has also been recommended [2,3]. Other manoeuvres include: positioning the tracheal cuff either just above the carina or above the operative site, ®lling the tracheal cuff with saline and packing uncuffed tracheal tubes.…”