Potential dangers of oxygen supplementation during facial surgery

The use of local anesthesia and intravenous sedation has made same-day outpatient surgery a viable option for many aesthetic and reconstructive procedures. These procedures often include the use of supplemental oxygen. Oxygen-enriched environments increase the combustibility of most materials, and "oxygen pooling" has been suspected to play an integral role in intraoperative fires. A personal experience with an intraoperative explosion and fire during a cosmetic blepharoplasty compelled us to explore the potential danger inherent in the use of supplemental oxygen as well as potential strategies to minimize that danger. This study systematically examines the microenvironment created by the use of oxygen both in the operative field and beneath the surgical drapes under conditions simulating routine facial surgery and various recommended modifications of its delivery. With the use of oxygen supplementation, oxygen concentration beneath the drapes was found to be consistently elevated when compared with ambient air (20.9 percent) and reached levels as high as 53.5 percent. Oxygen concentration in the operative environment was mildly but not significantly elevated. Although criteria for the use of oxygen supplementation are not clear, when administration is deemed necessary, the use of a posterior pharyngeal catheter for its delivery had no advantage over nasal prongs. However, appropriate alternatives include the use of "open face" draping techniques, the use of compressed air beneath the drapes as a substitute for oxygen supplementation in unsedated patients, and cessation of oxygen supplementation for 60 seconds prior to the use of a possible ignition source with oxygen flow rates of less than 3 liters per minute.