Heed the fire triangle for safe electrocautery

By Christopher Walsh, medwireNews Reporter

Most fires in the operating room (OR) are caused by electrocautery, according to a US review of surgical malpractice claims.

The predominant setting for these electrocautery-induced fires was monitored anesthesia care with supplemental oxygen delivered to the patient by an open delivery system, which presents a particularly high-risk combination.

The findings point to a clear need for education and communication to improve substandard anesthesia care, especially when electrocautery is used during procedures that create an oxygen-enriched environment, say Sonya Mehta (University of Washington, Seattle) and co-authors in Anesthesiology.

"Recognition of the fire triad, particularly the critical role of supplemental oxygen by an open delivery system during electrocautery use, is crucial to prevent OR fires," say the researchers.

Mehta and colleagues reviewed closed malpractice claims from the American Society of Anesthesiologists (ASA) Closed Claims Database to assess patterns of injury and liability associated with OR fires from 1985 to 2009.

Of the 5297 surgical malpractice claims made during that period, 103 (1.9%) involved OR fires.

Electrocautery was the source of ignition in 93 (90%) of the fire claims, and the majority (83%) of these fires occurred during monitored anesthesia care, with oxygen as the most common (95%) oxidizer.

By contrast, alcohol-containing solutions and other volatile compounds were involved in only 15% of OR fires.

Most (85%) electrocautery-induced fires occurred during head, neck, or upper-chest procedures, which have a high risk for fire, owing to the close proximity of the electrocautery device and the oxygen source.

It is important that anesthesiologists and surgeons recognize such high-fire-risk procedures and take steps to minimize the associated risks, say the authors. Possible solutions include using the lowest possible flow rate and concentration of supplemental oxygen required, using a sealed delivery system, ensuring that there are no leaks or ruptures in endotracheal tubes, and creating venting systems to prevent oxygen from collecting under surgical drapes.

Most importantly, the authors remind anesthesiologists that they should follow the recent recommendations of the ASA Practice Advisory for the prevention and management of OR fires.

Electrocautery-induced fires actually increased over time from less than 1% of all surgical claims in 1985-1994 to 4.4% in 2000-2009. However, the authors point out that the majority of fire claims in the study occurred before the 2008 publication of the ASA recommendations, and so it is difficult to assess their impact.

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