The Efficacy of a Midfacial Seal Drape in Reducing Oculofacial Surgical Field Fire Risk

Tao, Jeremiah; Hirabayashi, Kristin E.; Kim, Brian T.; Zhu, Feilin A.; Joseph, Jeffrey M.; Nunery, William R.

doi:10.1097/iop.0b013e31827defe1

Cited by 15 publications

(7 citation statements)

References 6 publications

(3 reference statements)

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“…2,3 A similar midface draping technique described by Tao et al has been shown to mitigate this risk by limiting the flow of supplemental oxygen toward the surgical field. 4 The adhesive 1010 drape should be well sealed across the face to minimize any potential gaps that can serve as tunnels for passage of oxygen or aerosols. 5,6 Our draping technique differs from the method described by Tao et al in that the entire inferior portion of the drape is elevated, rather than using a small venting slit at the chin.…”

Section: Discussionmentioning

confidence: 99%

Enhanced Draping for Oculoplastic Surgery to Minimize Respiratory Exposure During the COVID-19 Pandemic

Chow

Silkiss

2022

Am J Cosmet Surg

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Surgeons and surgical staff operating on the face are at risk of respiratory-based infectious transmission given their proximity to the patient’s nose and mouth in the surgical field. We describe a modified sterile draping technique that creates a midface seal with inferior ventilation that minimizes surgeon and staff exposure to patient respiratory emissions and potential transmission of infectious diseases, as well as mitigates fire risk during oculoplastic surgery and other surgeries involving the upper face.

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Section: Discussionmentioning

confidence: 99%

Enhanced Draping for Oculoplastic Surgery to Minimize Respiratory Exposure During the COVID-19 Pandemic

Chow

Silkiss

2022

Am J Cosmet Surg

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Section: Discussionmentioning

confidence: 99%

“…Minimization of oxygen delivery at all times and avoidance of (1) drape tenting and (2) creation of an OEA beneath the drapes that easily connects to the surgical field are broadly accepted recommendations. Examples of other posited solutions include a midfacial seal drape, discontinuation of nasal cannula, supplemental oxygen delivery via a modified nasopharyngeal tube further sealed with an ipsilateral ear plug in the nares, supplying sub‐100% oxygen‐gas mixtures via nasal cannula, air delivery at 5 to 10 LPM under the drapes to dilute the OEA, and cessation of supplemental oxygen for MAC cases altogether 36‐41 …”

Section: Discussionmentioning

confidence: 99%

“…Examples of other posited solutions include a midfacial seal drape, discontinuation of nasal cannula, supplemental oxygen delivery via a modified nasopharyngeal tube further sealed with an ipsilateral ear plug in the nares, supplying sub-100% oxygen-gas mixtures via nasal cannula, air delivery at 5 to 10 LPM under the drapes to dilute the OEA, and cessation of supplemental oxygen for MAC cases altogether. [36][37][38][39][40][41] Among patients scheduled for moderate to deep conscious sedation with an anticipated oxygen requirement and ignition source, the ASA-PA, ECRI, and JCAHO have recommended the following: (1) reassess general anesthesia preoperatively (ie, sealed gas delivery); (2) if MAC remains unavoidable, start FiO 2 delivery at 30% and increase only as necessary; (3) discontinue oxygen or use the minimum required to avoid hypoxia, and wait 1 to 3 minutes prior to the use of an ignition source. 1,4 Carefully Monitor Ignition Sources in the Operative Field: Safely Manage Heat Sources.…”

Section: Circulating Nursementioning

confidence: 99%

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Surgical Fires in Otolaryngology: A Systematic and Narrative Review

Day

Rivera

Farlow

et al. 2018

Otolaryngol.--head neck surg.

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Objective To bring attention to the epidemiology, prevention, management, and consequences of surgical fires in otolaryngology by reviewing the literature. Data Sources PubMed, EMBASE, Web of Science, and Scopus. Review Methods Comprehensive search terms were developed, and searches were performed from data source inception through August 2016. A total of 4506 articles were identified; 2351 duplicates were removed; and 2155 titles and abstracts were independently reviewed. Reference review was also performed. Eligible manuscripts described surgical fires involving patients undergoing otolaryngologic procedures. Results Seventy-two articles describing 87 otolaryngologic surgical fire cases were identified. These occurred during oral cavity or oropharyngeal procedures (11%), endoscopic laryngotracheal procedures (25%), tracheostomies (36%), "other" general anesthesia procedures (3%), and monitored anesthesia care or local procedures (24%). Oxidizing agents consisted of oxygen alone (n = 63 of 81, 78%), oxygen and nitric oxide (n = 17 of 81, 21%), and room air (n = 1 of 81, 1%). The fractional inspired oxygen delivered was >30% in 97% of surgical fires in non-nitrous oxide general anesthesia cases (n = 35 of 36). Laser-safe tubes were used in only 12% of endoscopic laryngotracheal cases with endotracheal tube descriptions (n = 2 of 17). Eighty-six percent of patients experienced acute complications (n = 76 of 87), including 1 intraoperative death, and 22% of patients (n = 17 of 77) experienced long-term complications. Conclusion Surgical fires in otolaryngology persist despite aggressive multi-institutional efforts to curb their incidence. Guideline recommendations to minimize the concentration of delivered oxygen and use laser-safe tubes when indicated were not observed in many cases. Improved institutional fire safety practices are needed nationally and internationally.

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“…j Suctioning/scavenger systems completely inhibit and/or reduce the qualitative severity of surgical fires [12,13]. j A mid-facial seal drape may reduce the intraoperative ORE [14].…”

Section: Role Of the Oxidizermentioning

confidence: 99%

Risks and prevention of surgical fires

et al. 2018

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Surgically induced fire is a life-threatening hazard; this topic has received little attention, although only 3 factors, the so-called fire triad, are needed for surgical fires to occur: an oxidizer, fuel and an ignition source. This systematic review aims to determine the impact of each component and to delegate every staff member an area of responsibility, thus ensuring patient health through prevention or protection. The trial was registered in Prospero CRD42018082656. A database search of eligible, preferably evidence-based studies was conducted. The Robins-I tool for assessing the risk of bias revealed a moderate risk of bias. Due to insufficient data, the main findings of these studies could not be summarized through a quantitative synthesis; therefore, a qualitative synthesis is outlined. The results are summarized according to the roles of the fire triad and discussed. (1) Role of the oxidizer: oxygen is the key component of the triad. Safe oxygen delivery is important. An oxygen-enriched environment (ORE) is caused by draping and is preferably prevented by suctioning. Fuel characteristics are affected by varying oxygen concentrations. (2) Role of the ignition source: electrocauterization is the most common ignition source, followed by lasers. Less common ignition sources include fiberoptic cables and preparative solutions, petrol or acetone. (3) Role of the fuel: surgical drapes are one of the most common fuels for surgical fires followed by the patient's hair and skin. Skin preparation solutions are among the less common fuels. Many fire-resistant materials have been tested that do not remain fire resistant in ORE. It was concluded that the main problem is defining the real extent of this hazard. Exact numbers and exact condition protocols are needed; therefore, standardized registration of every fire and future studies with much evidence are needed. Immediate prevention consists of close attention to patient safety to prevent surgical fires from happening.

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The Efficacy of a Midfacial Seal Drape in Reducing Oculofacial Surgical Field Fire Risk

Abstract: A midfacial seal drape reduced oxygen concentrations from nasal cannula oxygen in the oculofacial surgical field and may reduce fire risk.

Cited by 15 publications

References 6 publications

Enhanced Draping for Oculoplastic Surgery to Minimize Respiratory Exposure During the COVID-19 Pandemic

Enhanced Draping for Oculoplastic Surgery to Minimize Respiratory Exposure During the COVID-19 Pandemic

Surgical Fires in Otolaryngology: A Systematic and Narrative Review

Risks and prevention of surgical fires

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