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Operating Room Fires

Pollock, Harlan M.D.

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Plastic and Reconstructive Surgery: January 2009 - Volume 123 - Issue 1 - p 431
doi: 10.1097/PRS.0b013e31817c6b90
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I applaud the authors' goal of patient safety in the article entitled “Operating Room Fires: Optimizing Safety.”1 However, I believe a different approach is preferable, simple, and safe. The use of supplemental oxygen for facial surgery significantly adds to the risk of operating room fires, compromises the sterile field, and at a minimum adds an additional obstacle in the surgical field. It is my 40-year experience with conscious sedation/local anesthesia that the use of supplemental oxygen is unnecessary. The key, of course, is that anesthesia is provided by the local infiltration and/or nerve block, not by the depth of the intravenous sedation. Respirations and airway are easy to maintain, without interference with the surgical procedure and without jeopardizing patient safety. Patent airway and respiratory status is readily monitored clinically, and the pulse oximeter provides objective data on the level of oxygenation. The best way to avoid operating room fires related to the use of supplemental oxygen, especially for facial surgery, is avoid its use. If room air is adequate for awake patients, then it should be adequate for a patient under true conscious sedation, which the authors have appropriately described as the “patient maintaining spontaneous respirations.”

Harlan Pollock, M.D.

8305 Walnut Hill Lane, Suite 210

Dallas, Texas 75231


1. Meneghetti SC, Morgan MM, Fritz J, Borkowski RG, Djohan R, Zins JE. Operating room fires: Optimizing safety. Plast Reconstr Surg. 2007;120:1701–1708.

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