Fire in the operating room during tracheostomy

Fire in the modern operating room is still a constant danger today despite the usual absence of the historically explosive anesthetic gases, cyclopropane, and ether. During a tracheostomy, three conditions are present that will support an explosive or combustive event: heat, fuel and oxygen.

We report three routine tracheostomy cases during which a fire was ignited. One patient had a minor burn during the cauterizing of a bleeding vessel. There was a visible flame in all cases and, in one case, the cloth drapes ignited. There were no serious airway injuries to any patients and all had a complete and uneventful recovery. We duplicated the same conditions in our laboratory.

We discuss each case and give effective techniques to prevent ignition during surgery in the future. For our study, we reproduced flames in a cadaver trachea using halothane and the electrocautery in an oxygen-rich environment. We describe a protocol that has effectively prevented tracheostomy fires in our institution and may decrease the risk during other procedures as well. Also, we reviewed the literature to provide insight into the magnitude of the problem.

High-oxygen concentration, the presence of fuels such as suture and tissue, and an igniting spark from the electrocautery device produce the proper conditions for a fire during tracheostomy. Taking the proper precautions can minimize if not eliminate this risk.