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Electrocautery-induced ignition of tonsillar packing
M R Macdonald1, A Wong, P Walker
1Department of Otolaryngology, University of Toronto Faculty of Medicine, Hospital for Sick Children, Ontario.
The Journal of Otolaryngology
|December 1, 1994
Summary
Assisted ventilation during tonsillectomy can increase oxygen levels, raising the flammability risk of surgical packs. Bismuth-containing materials and partial saturation further heighten this combustion hazard.
Area of Science:
- Anesthesiology
- Surgical Safety
- Biomaterials Science
Background:
- A case of surgical pack ignition during tonsillectomy highlighted potential flammability risks.
- Standard surgical materials used for hemostasis may pose combustion hazards in specific clinical scenarios.
Purpose of the Study:
- To investigate local oxygen levels during tonsillectomy.
- To determine the influence of these oxygen levels on the flammability of common hemostatic materials.
Main Methods:
- Reproduced conditions similar to spontaneous and assisted ventilation in a laboratory setting.
- Compared flammability of cotton tonsil packs soaked in saline, adrenalin, or adrenalin and bismuth.
- Measured oxygen concentration changes during ventilation with airway leaks.
Main Results:
- Airway leaks during assisted ventilation significantly elevated local oxygen concentrations in 80% of pediatric cases.
- Elevated oxygen levels increased the combustibility of all tested surgical packs.
- Bismuth-containing materials exhibited increased flammability.
- Partially saturated packs were more combustible than fully saturated ones.
Conclusions:
- Assisted ventilation with airway leaks creates a hyperoxic environment during tonsillectomy, increasing surgical pack flammability.
- Bismuth-containing hemostatic agents may pose an additional ignition risk.
- Careful management of ventilation and material selection is crucial for preventing surgical fires.