Flooding With Carbon Dioxide Prevents Airway Fire Induced by Diathermy During Open Tracheostomy

Ho, Anthony M.‐H.; Wan, Song; Karmakar, Manoj K.

doi:10.1097/ta.0b013e31805f7011

Cited by 14 publications

(8 citation statements)

References 18 publications

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“…reported that flooding the surgical field with carbon dioxide prevented fires during tracheostomy in pigs. [ 11 ] This is an interesting finding that needs to be evaluated further in humans.…”

Section: Discussionmentioning

confidence: 99%

Airway fires during surgery: Management and prevention

Akhtar¹,

Ansar²,

Baig³

et al. 2016

J Anaesthesiol Clin Pharmacol

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Airway fires pose a serious risk to surgical patients. Fires during surgery have been reported for many years with flammable anesthetic agents being the main culprits in the past. Association of airway fires with laser surgery is well-recognized, but there are reports of endotracheal tube fires ignited by electrocautery during pharyngeal surgery or tracheostomy or both. This uncommon complication has potentially grave consequences. While airway fires are relatively uncommon occurrences, they are very serious and can often be fatal. Success in preventing such events requires a thorough understanding of the components leading to a fire (fuel, oxidizer, and ignition source), as well as good communication between all members present to appropriately manage the fire and ensure patient safety. We present a case of fire in the airway during routine adenotonsillectomy. We will review the causes, preventive measures, and brief management for airway fires.

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Section: Discussionmentioning

confidence: 99%

Airway fires during surgery: Management and prevention

Akhtar¹,

Ansar²,

Baig³

et al. 2016

J Anaesthesiol Clin Pharmacol

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“…Bailey et al [ 6 ] recommended that the following minimal precautions be taken to prevent fires during elective tracheostomy: 1) oxygen–air and/or helium mixtures (as permitted by patient condition) be used to reduce combustibility; 2) electrocautery devices be used sparingly, and if used, the voltage be set at a low level, particularly when the trachea is exposed during surgical resection; 3) a bipolar rather than a unipolar electrocautery device be used to prevent/minimize current leakage; and 4) saline or water be used instead of air to inflate the endotracheal tube cuff. Ho et al [ 7 ] reported that CO 2 flooding of the surgical field reduces the risk of fire in patients who cannot tolerate ventilation interruption or require high inspired O 2 concentrations.…”

Section: Discussionmentioning

confidence: 99%

Electrocautery-Ignited Surgical Field Fire Caused by a High Oxygen Level during Tracheostomy

Kim

Lee

et al. 2014

Korean J Thorac Cardiovasc Surg

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Tracheostomy is a relatively common surgical procedure that is performed easily in an operating room or intensive care unit. Open tracheostomy is needed in patients requiring prolonged ventilation when percutaneous tracheostomy is inappropriate. Sometimes, it is difficult to achieve bleeding control in the peritracheal soft tissue, and in such cases, we usually use diathermy. However, the possibility of an electrocautery-ignited surgical field fire can be overlooked during the procedure. This case report serves as a reminder that the risk of a surgical field fire during tracheostomy is real, particularly in patients requiring high-oxygen therapy.

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“…Some surgeons prefer diathermy to scalpels [4], especially in patients with haemostatic deficiencies; even if a scalpel is used to incise the airway, diathermy may be required to secure haemostasis [3]; some critically ill patients, precisely those who require double-lung transplant off-pump, may not tolerate apnoea or the use of low concentration of oxygen. In addition to using the lowest possible voltage for the electrocautery [3], the surgical field should be flooded with carbon dioxide [5].…”

Section: Discussionmentioning

confidence: 99%