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Endotracheal tube safety during electrodissection tonsillectomy.
C Keller1, W Elliott, R N Hubbell
1Division of Otolaryngology-Head and Neck Surgery, University of Vermont, Burlington.
Archives of Otolaryngology--Head & Neck Surgery
|June 1, 1992
Summary
An endotracheal tube fire during tonsillectomy was likely caused by oxygen buildup around the tube. In vitro tests showed higher oxygen concentrations increased ignition risk, but tubes were safe above 52% oxygen.
Area of Science:
- Anesthesiology
- Otolaryngology
- Medical Device Safety
Background:
- Electrocautery is frequently used in tonsillectomy.
- Endotracheal intubation is standard for airway management during general anesthesia.
Observation:
- A fire involving an endotracheal tube occurred during electrodissection tonsillectomy.
- The incident is hypothesized to result from a retrograde leak of ventilating gases, creating a high oxygen concentration in the oral cavity.
Findings:
- In vitro testing demonstrated that increased oxygen concentration lowers the ignition threshold for polyvinylchloride endotracheal tubes when exposed to electrocautery.
- Ignition was not achieved at 52% oxygen concentration with a 25-W coagulation current.
Implications:
- This case highlights the risk of endotracheal tube fires during procedures using electrocautery in oxygen-enriched environments.
- Recommendations are provided to mitigate this risk, emphasizing careful monitoring of oxygen concentration and ventilation techniques.