Airway fire with use of diathermy in conjunction with high-flow nasal oxygen

Operating theatre fires are rare but can result in significant morbidity. A 76-year-old male with complex airway disease sustained superficial facial burns during an elective airway debulking procedure. His airway was being managed with high-flow nasal oxygen at 70 l.min^-1 and FiO₂ 1.0 delivered by Optiflow™ (Fisher and Paykel Healthcare Limited, Auckland, New Zealand). When suction monopolar diathermy was used to excise hyperkeratotic tissue beside his epiglottis, an arc was created to the tip of the suspension laryngoscope, followed by a jet of flame as the Optiflow circuit ignited. This resulted in burns to the patient's face and shoulder. He required admission to the intensive care unit and had a complicated postoperative course that included the need for surgical tracheostomy to facilitate weaning from mechanical ventilation. This case highlights the dangers of using high-flow nasal oxygen alongside an ignition source.