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Fire safety in the operating room

Rinder, Christine Stowe

Current Opinion in Anesthesiology: December 2008 - Volume 21 - Issue 6 - p 790–795
doi: 10.1097/ACO.0b013e328318693a
Technology, education and training: Edited by Kirk Shelley

Purpose of review Elimination of flammable anesthetic gases has had little effect on operating-room fires except to change their etiology. Electrocautery and lasers, in an oxygen-enriched environment, can ignite even the most fire-resistant materials, including the patient, and the fire triad possibilities in the operating room are nearly limitless. This review will: identify operating room contents capable of acting as ignition/oxidizer/fuel sources, highlight operating room items that are uniquely potent fire triad contributors, and operating room identify settings where fire risk is enhanced by proximity of triad components in time or space.

Recent findings Anesthesiologists are cognizant of the risk of airway surgery fires due to laser ignition of the endotracheal tube and/or its contents. Recently, however, head/neck surgery under monitored anesthesia care has emerged as a high-risk setting for operating room fires; burn injuries represent 20% of monitored anesthesia care-related malpractice claims, 95% of which involved head/neck surgery.

Summary Operating room fires are infrequent but catastrophic. Operating room fire prevention depends on: (a)understanding how fire triad elements interact to create a fire, (b) recognizing how standard operating-room equipment, materials, and supplemental oxygen can become one of those elements, and (c) vigilance for circumstances that bring fire triad elements into close proximity.

Departments Anesthesiology and Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA

Correspondence to Christine Stowe Rinder, Anesthesiology Department, Tompkins 3, Yale University School of Medicine, New Haven, CT 06520, USA Tel: +1 203 785 2802; fax: +1 203 688 8597; e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.