A prototype device attached to a pencil tip electrosurgical unit helped eliminate OR fires. (Image source: Anesthesia & Analgesia)
A prototype device attached to a pencil tip electrosurgical unit helped eliminate OR fires. (Image source: Anesthesia & Analgesia)

Operating room fires are preventable, but they still occur.  For an OR fire to take place, oxygen, a fuel source (endotracheal tubes, hair, alcohol prep), and an ignition source (electrosurgical pencil tip) are all that is needed.  When there’s the possibility of fire, we all know to keep oxygen levels low, to avoid nitrous oxide (also an oxidizing agent), to utilize appropriate endotracheal tubes, and to avoid alcohol-based antiseptic agents.  If proper technique is followed, then OR fires are theoretically preventable, yet they still occur.  Can something else be done?

Dr. William C. Culp, Jr., Department of Anesthesiology, Texas A&M University Health Science Center College Of Medicine, Scott & White Hospital, Temple, Texas, and colleagues devised a technique that would generate a cone of carbon dioxide around the electrosurgical unit pencil tip. The device they created and tested is described in the article titled “Mitigating Operating Room Fires: Development of a Carbon Dioxide Fire Prevention Device” that appears in this month’s issue of Anesthesia & Analgesia.

The authors’ device was connected to a CO2 source and was then secured to the cautery pencil tip.  They tested their device by trying to ignite a laparotomy sponge, a very flammable material, with the electrosurgical tip. They examined the time to ignition using different oxygen concentrations in a test chamber with CO2 off or flowing at a rate of 8 L/ min.  Regardless of the concentration of oxygen, with the electrosurgical tip in operation for 30 seconds, no fire was observed when CO2 was flowing.  When CO2 was not flowing, ignition occurred with 100% oxygen in less than 0.5 sec.

The authors created a prototype to undertake additional testing. Once this comes to market, and assuming that surgeons will use the device, the risk of operating room fires should be greatly reduced.

As Dr. Jeffrey M. Feldman, Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA and colleagues from the Department of Anesthesiology, Yale University School of Medicine, New Haven, CT and the Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL note in the accompanying editorial “Thinking Outside the Triangle: A New Approach to Preventing Surgical Fires,” “Culp et al. are to be congratulated for taking a unique approach to surgical fire prevention.  The technique of insufflating CO2 around the heat source effectively breaks the fire triangle by excluding the used catalytic and thermal oxidizers from the heat source.  This approach is different from the current recommendations to simply limit the oxygen concentration delivered, but requires additional investigation before it can be considered suitable for clinical practice.  This technique may provide another layer of prevention for high risk procedures where electrocautery is used. Perhaps a similar approach could be developed for surgical lasers, another important ignition source for surgical fires. “