Intraoperative Fire Safety

• Interventions for fire safety during MAC
  • Keep the face draping open as opposed to tenting.
  • Titrate the oxygen delivery to the lowest acceptable level according to pulse oximetry.
  • Use compressed air instead of oxygen to prevent carbon dioxide accumulation.
  • Avoid alcohol-based prep solutions.
  • Awareness of the causes and prevention of surgical fires.

REFERENCE: Barash Clinical Anesthesia 9th edition, page 802

• The limbs of the “fire triad” are a heat or ignition source, fuel, and an oxidizer. The main oxidizers in the OR are air, oxygen, and nitrous oxide. Fires occurring on the patient mainly involve head and neck surgery done under regional anesthesia or monitored anesthesia care when the patient is receiving high flows of supplemental oxygen.
• Airway fire is the most serious complication of airway laser surgery. Recommendations to lessen the chances of an airway fire:
  • Attention and vigilance
  • Limit oxygen concentration
  • Use suction under the drape to prevent entrapment of gases
• Oxygen delivery should be stopped for 1 minute during a laser ENT surgery using electrocautery.
• The fire hazard can be greatly reduced or eliminated by removing the oxygen source and ETT.
  • The first step in an airway fire during laser surgery is to simultaneously stop ventilation and extubate.