Operating room fires are potentially life-threatening events. Despite being casuistry, they are a real danger and their occurrence nowadays is mainly because the surgical team lacks knowledge on fire safety and deviates from current established practical recommendations for the prevention of such events.
Interventions in otorhinolaryngology and head and neck surgery are associated with a particularly high risk of fire. This is due to the proximity of the components of the so-called fire triangle in these interventions.
The most common causes and mechanisms of fire are well established—the main factor in otorhinolaryngology is the activation of an energy-based surgical instrument close to the endotracheal tube or in an oxygen-rich environment, and the majority of the accidents occur due to the lack of awareness of the functioning of the equipment used and the potential fire risk. However, the recommendations for fire prevention and algorithms for behaviour in cases of fire in the operating room are contradictory or incomplete.
The lack of a unified strategy at a local, national or international level, as well as the lack of theoretical and practical training of the personnel involved in the surgical work lead to a large number of potentially preventable similar events, the real number of which could not be estimated because their registration is not mandatory and is usually undesirable due to potential legal risk.
Akhtar, N., Ansar, F., Baig, M. S., & Abbas, A. (2016). Airway fires during surgery: Management and prevention. Journal of Anaesthesiology, Clinical Pharmacology, 32(1), 109–111. https://doi.org/10.4103/0970-9185.175710
Apfelbaum, J. L., Caplan, R. A., Barker, S. J., Connis, R. T., Cowles, C., Ehrenwerth, J., Nickinovich, D. G., Pritchard, D., Roberson, D. W., Caplan, R. A., Barker, S. J., Connis, R. T., Cowles, C., de Richemond, A. L., Ehrenwerth, J., Nickinovich, D. G., Pritchard, D., Roberson, D. W., Wolf, G. L., & American Society of Anesthesiologists Task Force on Operating Room Fires. (2013). Practice advisory for the prevention and management of operating room fires: An updated report by the American Society of Anesthesiologists Task Force on Operating Room Fires. Anesthesiology, 118(2), 271–290. https://doi.org/10.1097/ALN.0b013e31827773d2
Authority, P. P. S. (n.d.). Airway Fires during Surgery | Advisory. Pennsylvania Patient Safety Authority. Retrieved October 30, 2021, from http://patientsafety.pa.gov:80/ADVISORIES/Pages/200703_01b.aspx
Braungart, S., McNaught, C., MacFie, J., & Peter, M. (2016). Not getting our fingers burnt: Do surgeons know enough about energy devices? The Bulletin of the Royal College of Surgeons of England, 98(6), 244–247. https://doi.org/10.1308/rcsbull.2016.244
Burgess, G. E., & LeJeune, F. E. (1979). Endotracheal tube ignition during laser surgery of the larynx. Archives of Otolaryngology (Chicago, Ill.: 1960), 105(9), 561–562. https://doi.org/10.1001/archotol.1979.00790210059013
Cowles, C. E., & Culp, W. C. (2019). Prevention of and response to surgical fires. BJA Education, 19(8), 261–266. https://doi.org/10.1016/j.bjae.2019.03.007
Day, A. T., Rivera, E., Farlow, J. L., Gourin, C. G., & Nussenbaum, B. (2018). Surgical Fires in Otolaryngology: A Systematic and Narrative Review. Otolaryngology--Head and Neck Surgery: Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 158(4), 598–616. https://doi.org/10.1177/0194599817746926
ECRI Institute. (2009). New clinical guide to surgical fire prevention. Patients can catch fire—Here’s how to keep them safer. Health Devices, 38(10), 314–332.
Feldman, L. S., Fuchshuber, P., Jones, D. B., Mischna, J., Schwaitzberg, S. D., & FUSE (Fundamental Use of Surgical EnergyTM) Task Force. (2012). Surgeons don’t know what they don’t know about the safe use of energy in surgery. Surgical Endoscopy, 26(10), 2735–2739. https://doi.org/10.1007/s00464-012-2263-y
Ghafouri, R., Bashkam, M. B., Ghafouri, R., & Bashkam, M. B. (2020). Surgical fire in operating room- A meta synthesis. World Journal of Advanced Research and Reviews, 7(2), 314–319. https://doi.org/10.30574/wjarr.2020.7.2.0310
Gorphe, P., Sarfati, B., Janot, F., Bourgain, J. L., Motamed, C., Blot, F., & Temam, S. (2014). Airway fire during tracheostomy. European Annals of Otorhinolaryngology, Head and Neck Diseases, 131(3), 197–199. https://doi.org/10.1016/j.anorl.2013.07.001
GREENE, B. A. (1941). THE HAZARD OF FIRE AND EXPLOSION IN ANESTHESIA: REPORT OF A Original Investigations OF 230 CASES. Anesthesiology, 2(2), 144–160. https://doi.org/10.1097/00000542-194103000-00003
GREENE, B. A. (1942). Hazards of Fire and Explosion of Anesthetic Agents. Anesthesiology, 3(4), 477. https://doi.org/10.1097/00000542-194207000-00043
Greenland, K. B., Stokan, M. J., & Culwick, M. D. (2019). Operating theatre fires: Adding more oxygen to the mix. Anaesthesia and Intensive Care, 47(4), 399–400. https://doi.org/10.1177/0310057X19860976
Heijman, K., Heijman, L., Jonzon, A., Sedin, G., Sjöstrand, U., & Widman, B. (1972). High Frequency Positive Pressure Ventilation During Anaesthesia and Routine Surgery in Man. Acta Anaesthesiologica Scandinavica, 16(3), 176–187. https://doi.org/10.1111/j.1399-6576.1972.tb00588.x
Huang, L., Athanasiadis, T., Vermeulen, M., Woods, C., Badenoch, A., Ullah, S., & Ooi, E. H. (2020). Risk of airway fire with use of KTP laser and high flow humidified oxygen delivery in a laryngeal surgery model: November Annual Academic Surgery Conference. 27. https://www.surgeons.org/-/media/Project/RACS/surgeons-org/files/interest-groups-sections/academic-surgery/Academic-Surgery-Conference-Program---Final.pdf?rev=8f6468150e734fe18823eedc78d3d488&hash=66058CEAD60359277530C932450624C3
Jones, S. B., Munro, M. G., Feldman, L. S., Robinson, T. N., Brunt, L. M., Schwaitzberg, S. D., Jones, D. B., & Fuchshuber, P. R. (2017). Fundamental Use of Surgical Energy (FUSE): An Essential Educational Program for Operating Room Safety. The Permanente Journal, 21, 16–050. https://doi.org/10.7812/TPP/16-050
Jones, T. S., Black, I. H., Robinson, T. N., & Jones, E. L. (2019). Operating Room Fires. Anesthesiology, 130(3), 492–501. https://doi.org/10.1097/ALN.0000000000002598
Link, T. (2021). Guidelines in Practice: Electrosurgical Safety. AORN Journal, 114, 60–72. https://doi.org/10.1002/aorn.13421
Mehta, S. P., Bhananker, S. M., Posner, K. L., & Domino, K. B. (2013). Operating room fires: A closed claims analysis. Anesthesiology, 118(5), 1133–1139. https://doi.org/10.1097/ALN.0b013e31828afa7b
Overbey, D. M., Townsend, N. T., Chapman, B. C., Bennett, D. T., Foley, L. S., Rau, A. S., Yi, J. A., Jones, E. L., Stiegmann, G. V., & Robinson, T. N. (2015). Surgical Energy-Based Device Injuries and Fatalities Reported to the Food and Drug Administration. Journal of the American College of Surgeons, 221(1), 197-205.e1. https://doi.org/10.1016/j.jamcollsurg.2015.03.031
Pollock, G. S. (2004). Eliminating surgical fires: A team approach. AANA Journal, 72(4), 293–298.
Roy, S., & Smith, L. P. (2015). Prevention of airway fires: Testing the safety of endotracheal tubes and surgical devices in a mechanical model. American Journal of Otolaryngology, 36(1), 63–66. https://doi.org/10.1016/j.amjoto.2014.10.009
Sapundzhiev, N., Chalakov, I., Zenev, I., Kovachev, T., & Hartova, A. (2006). Tubusbrand bei der Laserchirurgie in den Luftwegen—Sofortmassnahmen. GMS Current Posters in Otorhinolaryngology - Head and Neck Surgery, 2, Doc042.
Sapundzhiev, N. R., Davidov, G., Platikanov, V., Stoyanov, G. S., & Ignatov, V. (n.d.). Anesthesia-related Safety Profile of a High-energy Ultrasonic Scalpel in Oropharyngeal and Laryngeal Surgery: An Ex Vivo Model. Cureus, 11(7). https://doi.org/10.7759/cureus.5266
Smith, L. P., & Roy, S. (2008). Fire/burn risk with electrosurgical devices and endoscopy fiberoptic cables. American Journal of Otolaryngology, 29(3), 171–176. https://doi.org/10.1016/j.amjoto.2007.05.006
Smith, L. P., & Roy, S. (2011). Operating room fires in otolaryngology: Risk factors and prevention. American Journal of Otolaryngology, 32(2), 109–114. https://doi.org/10.1016/j.amjoto.2009.11.004
Stuermer, K. J., Ayachi, S., Gostian, A.-O., Beutner, D., & Hüttenbrink, K.-B. (2013). Hazard of CO₂ laser-induced airway fire in laryngeal surgery: Experimental data of contributing factors. European Archives of Oto-Rhino-Laryngology: Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): Affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 270(10), 2701–2707. https://doi.org/10.1007/s00405-013-2521-1
Ventura Spagnolo, E., Mondello, C., Roccuzzo, S., Baldino, G., Sapienza, D., Gualniera, P., & Asmundo, A. (2021). Fire in operating room: The adverse “never” event. Case report, mini-review and medico-legal considerations. Legal Medicine (Tokyo, Japan), 51, 101879. https://doi.org/10.1016/j.legalmed.2021.101879
Werkhaven, J. A. (2004). Microlaryngoscopy-airway management with anaesthetic techniques for CO(2) laser. Paediatric Anaesthesia, 14(1), 90–94. https://doi.org/10.1046/j.1460-9592.2003.01195.x
Yardley, I. E., & Donaldson, L. J. (2010). Surgical fires, a clear and present danger. The Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland, 8(2), 87–92. https://doi.org/10.1016/j.surge.2010.01.005
доц. Н. Сапунджиев д.м. (2021). Специфични основни положения при оперативни интервенции в оториноларингологията и хирургията на главата и шията. In Ръководство за практическо обучение по специалността „Ушни, носни и гърлени болести".
Чалъков Ив., Сапунджиев Н., Ценев И., Ковачев Т., Мирчева М. (n.d.). Запалване на ендоларингеална тръба по време на лазерна микроларингохирургия—Клиничен случай и анализ,. Международен Бюлетин По Оториноларингология,1, с. 6-9, 2009 г.
