Incidental operating room fire from a breathing circuit warmer system: a case report

Background An airway-associated fire in an operating room can have devastating consequences for patients. Breathing circuit warmers (BCWs) are widely used to provide heated and humidified anesthetic gases and eventually prevent hypothermia during general anesthesia. Herein, we describe a case of a BCW-related airway fire. Case presentation In this case, an electrical short within a BCW wire caused a fire inside the circuit. Simultaneously, the fire was extinguished, ventilation was stopped, and the endotracheal tube was disconnected from the BCW. The patient was exposed to the fire for less than 10 s, resulting in burns to the trachea and bronchi. Immediately after airway burn, bronchoscopy showed no edema or narrowing except for soot in the trachea and both main bronchus. After the inhalation burn event, prophylactic antibiotics, bronchodilator, mucolytics nebulizer, and corticosteroid nebulizer were started. On bronchoscopy 3 days after the inhalation burn, mucosal erythematous edema was observed and the inflammatory reaction worsened. The inflammatory reaction showed aggravation for up to 2 weeks, and then gradually recovered, and the epithelium and mucous membrane of the upper respiratory tract returned to normal after 4 weeks. Eventually, the patient recovered without long-term complications and was successfully discharged. Conclusions This is the first report of a fire caused by BCW. We wanted to share our experience of how we responded to an airway-related fire in an OR and treated the patient. It cannot be overemphasized that the electrical medical appliance associated with the airways are fatal to the patient in the event of a fire, so caution should always be exercised.

Beyond Genes: Germline Disruption in the Etiology of Autism Spectrum Disorders

Investigations into the etiology of autism spectrum disorders have been largely confined to two realms: variations in DNA sequence and somatic developmental exposures. Here we suggest a third route—disruption of the germline epigenome induced by exogenous toxicants during a parent’s gamete development. Similar to cases of germline mutation, these molecular perturbations may produce dysregulated transcription of brain-related genes during fetal and early development, resulting in abnormal neurobehavioral phenotypes in offspring. Many types of exposures may have these impacts, and here we discuss examples of anesthetic gases, tobacco components, synthetic steroids, and valproic acid. Alterations in parental germline could help explain some unsolved phenomena of autism, including increased prevalence, missing heritability, skewed sex ratio, and heterogeneity of neurobiology and behavior.

Microclimatic and Environmental Surveillance of Operating Theaters: Trend and Future Perspectives

The health risk level in operating rooms is correlated to the safety levels of microclimatic parameters, thermal indices, anesthetic gases and microbiological parameters. The objective of this study was to estimate the staff and medical service management compliance with the suggestions resulting from monitoring. Methods: The environmental conditions of 38 different operating rooms in the Sicily region, Italy, from January 2011 to December 2020 were monitored. The results were compared with specific standards suggested by national and international laws and guidelines. Results: Almost all microclimatic and microbiological parameters were outside the limits. The monitoring of the anesthetic gases showed that 5.6% of sevoflurane measurements exceeded the limit values. Conclusions: Constant environmental monitoring is an essential element for maintaining optimal living conditions in the working environment. The compliance of staff with guidelines and rules is a fundamental parameter for achieving this objective.

Comparison Between Isoflurane and Sevoflurane on Pulse Rate in Patients Under Going General Surgery

The inhalational agents are very important to maintain the depth of anesthesia, provide analgesia and muscle relaxant. Many factors have effect of anesthetic gases, including type in an anesthetic agents and its MAC and other properties and postoperative stays. This study were designed to comparison between isoflurane and sevoflurane as inhalational agents on the pulse rate during general anesthesia. This prospective study were carried out at Baghdad Teaching Hospital, Medical City Complex, Baghdad/Iraq from 2nd January 2020 – 20th February 2020. Thirty (30) patients between 7 - 68 years old were enrolled in this study. Male was 13 and female was 17, in all selected patients, pulse rate was recorded at baseline, at intubation at 5 min, 10 min, 15 min, 20 min, 25 min, 30min, 40 min of the time of operation, extubation, and recovery. Results showed that the pulse rate at baseline there is not significant different in pulse rate of each gas, at intubation there is significant change in pulse rate, at 5 min ,10 min, 15 min, 20 min, 25 min, 30 min, 40 min, extubation, recovery there is not significant different in pulse rate.

Chemical risk in hospital settings: Overview on monitoring strategies and international regulatory aspects

Chemical risk in hospital settings is a growing concern that health professionals and supervisory authorities must deal with daily. Exposure to chemical risk is quite different depending on the hospital department involved and might origin from multiple sources, such as the use of sterilizing agents, disinfectants, detergents, solvents, heavy metals, dangerous drugs, and anesthetic gases. Improving prevention procedures and constantly monitoring the presence and level of potentially toxic substances, both in workers (biological monitoring) and in working environments (environmental monitoring), might significantly reduce the risk of exposure and contaminations. The purpose of this article is to present an overview on this subject, which includes the current international regulations, the chemical pollutants to which medical and paramedical personnel are mainly exposed, and the strategies developed to improve safety conditions for all healthcare workers.