Intrathoracic fire during preparation of the left internal thoracic artery for coronary artery bypass grafting

Friedrich, Martin; Tirilomis, Theodor; Schmitto, Jan D.; Popov, Aron Frederik; Mokashi, Suyog A.; Hinterthaner, Marc; Hanekop, G. G.; Zwaka, PA; Schoendube, Friedrich A.

doi:10.1186/1749-8090-5-10

Cited by 6 publications

(3 citation statements)

References 13 publications

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“…Friedrich et al reported a case of intrathoracic fire during coronary artery bypass grafting, when a gauze sponge caught fire when electrocautery was introduced. 8 Obvious ignition sources like electrosurgical equipment is involved 68% of the time. 4 The cutting mode of electrocautery in particular is more hazardous than coagulation mode.…”

Section: Discussionmentioning

confidence: 99%

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Surgical fire caused by electrocautery in ambient air

Tan

Thong

2015

Proceedings of Singapore Healthcare

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Introduction: The fire triangle comprises the ignition source, fuel and oxidizer which is necessary for the initiation of fire. Most surgical fires occur in an oxygen-enriched environment. We report a case of surgical fire in ambient air where an alcohol-based antiseptic was involved. Case report: A 20-year-old male diagnosed with left pleural empyema and respiratory failure, requiring emergent intubation and respiratory support, was brought into the operating theatre for decortication of the left lung. Shortly after induction, the patient desaturated despite 100% oxygen and lung recruitment manoeuvres. The surgical team decided to insert a chest tube emergently to drain the empyema to improve respiratory function. A non-functioning drainage catheter that was in situ was removed and placed on the operating table beside the patient. Skin was prepared using chlorhexidine gluconate 0.5% w/v in methylated spirit solution and iodine. Soon after, cotton drapes were used to cover the patient. After the initial incision for chest tube insertion, electrocautery was introduced. Smoke and a smell of something burning was immediately noted by the surgical team. The drapes were removed and the drainage catheter with a burnt tip was discovered beside the patient. The patient suffered second degree burns to his chest wall. Conclusion: Although it is more common for surgical fires to occur in an oxygen-enriched environment, this case highlights that without adequate precautions they can also occur in ambient air. Recognition that standard anaesthetic and surgical equipment can act as sources of fuel and vigilance for the circumstances that complete the fire triangle are key to the prevention of surgical fires.

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Section: Discussionmentioning

confidence: 99%

“…Friedrich et al reported a case of intrathoracic fire during coronary artery bypass grafting, when a gauze sponge caught fire when electrocautery was introduced. 8…”

Section: Discussionmentioning

confidence: 99%

Surgical fire caused by electrocautery in ambient air

Tan

Thong

2015

Proceedings of Singapore Healthcare

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“…Friedrich et al 76 reported a case in which an intrathoracic fire developed following a lung injury leak of high oxygen concentration in a patient with severe chronic obstructive pulmonary disease during coronary artery bypass graft surgery with left internal thoracic artery harvesting. Electrocautery or laser likely led to intrathoracic ignition in an oxygen-rich environment.…”

Section: Fire During Thoracic Proceduresmentioning

confidence: 99%

Current Practice Issues in Thoracic Anesthesia

Cohen

2021

Anesthesia &Amp; Analgesia

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This review discusses the present strategies in lung separation, the various types of double-lumen tubes (DLTs), and the use of bronchial blockers (BBs). Methods of selecting the correct DLT size and the role of videolaryngoscopy in placing a DLT are reviewed. Mechanisms whereby inhaled anesthetics may be protective during one-lung ventilation (OLV) are highlighted. The risk and prevention of fire during thoracic procedures are discussed.

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