Surgical fires: perioperative communication is essential to prevent this rare but devastating complication

Bruley, Mark E.

doi:10.1136/qshc.2003.005819

Cited by 48 publications

(30 citation statements)

References 17 publications

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“…S urgical fires are well-characterized, 1,2 readily preventable, 3 and potentially devastating 4 operating room catastrophes that continue to occur as often as 600 times per year in US operating rooms, sometimes with fatal results. 5 A review of the literature by VanCleave et al 6 on dental surgical fires specifically, and surgical fires more generally, however, yielded few conclusive answers with respect to the characterization of conditions that can result in actual in situ dental surgical fires.…”

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confidence: 99%

The Effect of Intraoral Suction on Oxygen-Enriched Surgical Environments: A Mechanism for Reducing the Risk of Surgical Fires

VanCleave

Jones

McGlothlin

et al. 2014

Anesthesia Progress

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In this study, a mechanical model was applied in order to replicate potential surgical fire conditions in an oxygen-enriched environment with and without high-volume suction typical for dental surgical applications. During 41 trials, 3 combustion events were measured: an audible pop, a visible flash of light, and full ignition. In at least 11 of 21 trials without suction, all 3 conditions were observed, sometimes with an extent of fire that required early termination of the experimental trial. By contrast, in 18 of 20 with-suction trials, ignition did not occur at all, and in the 2 cases where ignition did occur, the fire was qualitatively a much smaller, candle-like flame. Statistically comparing these 3 combustion events in the no-suction versus with-suction trials, ignition (P ¼ .0005), audible pop (P ¼ .0211), and flash (P ¼ .0092) were all significantly more likely in the no-suction condition. These results suggest a possible significant and new element to be added to existing surgical fire safety protocols toward making surgical fires the ''never-events'' they should be.

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confidence: 99%

The Effect of Intraoral Suction on Oxygen-Enriched Surgical Environments: A Mechanism for Reducing the Risk of Surgical Fires

VanCleave

Jones

McGlothlin

et al. 2014

Anesthesia Progress

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“…6 This paucity of case studies may be due to underreporting. 10,11 It is unclear whether all states are now required to report surgical fires. In 2003, Washington, California, and Tennessee were the only states to do so, and federal reporting was triggered only in cases of equipment failure.…”

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confidence: 99%

“…16,17 They have been described as completely preventable 18 and as 1 of 3 ''never events,'' along with left-behind surgical materials and wrong-site surgery, that should never occur in medical practice. 19 Nonetheless, they continue to occur, often with devastating 10 and sometimes fatal consequences.…”

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confidence: 99%

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confidence: 99%

“…10 Barker and Polson 21 may have been among some of the first to attempt to identify and recreate the conditions of an actual operating room fire. With the decline in use of flammable anesthetics, the general concern for and awareness of fire safety in the operating room declined 10 ; this awareness has yet to return to previous levels. 22,23 Subsequently, the vastly increased use of laser and electrocautery equipment has reintroduced an increased risk of surgical fires, 10 despite many long-standing safety protocols for laser equipment.…”

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confidence: 99%

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Factors Involved In Dental Surgery Fires: A Review of the Literature

VanCleave

Jones

McGlothlin

et al. 2014

Anesthesia Progress

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Surgical fires are well-characterized, readily preventable, potentially devastating operating room catastrophes that continue to occur from 20 to 100 times per year or, by one estimate, up to 600 times per year in US operating rooms, sometimes with fatal results. The most significant risk factors for surgical fires involve (a) the use of an ignition source, such as laser or electrocautery equipment, in or around an oxygen-enriched environment in the head, neck, and upper torso area and (b) the concurrent delivery of supplemental oxygen, especially via nasal cannula. Nonetheless, while these 2 conditions occur very commonly in dental surgery, especially in pediatric dental surgery where sedation and anesthesia are regularly indicated, there is a general absence of documented dental surgical fires in the literature. Barring the possibility of underreporting for fear of litigation, this may suggest that there is another mechanism or mechanisms present in dental or pediatric dental surgery that mitigates this worst-case risk of surgical fires. Some possible explanations for this include: greater fire safety awareness by dental practitioners, incidental ventilation of oxygen-enriched environments in patient oral cavities due to breathing, or suction used by dental practitioners during procedures. This review of the literature provides a background to suggest that the practice of using intraoral suction in conjunction with the use of supplemental oxygen during dental procedures may alter the conditions needed for the initiation of intraoral fires. To date, there appear to be no published studies describing the ability of intraoral suctioning devices to alter the ambient oxygen concentration in an intraoral environment. In vivo models that would allow examination of intraoral suction on the ambient oxygen concentration in a simulated intraoral environment may then provide a valuable foundation for evaluating the safety of current clinical dental surgical practices, particularly in regard to the treatment of children.

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Challenges in Preventing Electrical, Thermal, and Radiation Injuries

Bruley

2017

Surgical Patient Care

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Surgical fires: perioperative communication is essential to prevent this rare but devastating complication

Cited by 48 publications

References 17 publications

The Effect of Intraoral Suction on Oxygen-Enriched Surgical Environments: A Mechanism for Reducing the Risk of Surgical Fires

The Effect of Intraoral Suction on Oxygen-Enriched Surgical Environments: A Mechanism for Reducing the Risk of Surgical Fires

Factors Involved In Dental Surgery Fires: A Review of the Literature

Challenges in Preventing Electrical, Thermal, and Radiation Injuries

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