Prevention of surgical fires in facial plastic surgery

Introduction: The objective of this review is to draw attention to the risk factors, causes and prevention of surgical fires in facial plastic and reconstructive surgery performed under local anaesthesia and sedation using a review of the literature.Method: Comprehensive search terms were developed, and PubMed and MEDLINE® searches were performed, including articles published in the last 25 years (1993–2018). Reference review was also undertaken. Eligible manuscripts described surgical fires involving patients undergoing surgical procedures under local anaesthesia in the head and neck region.Results: Risk factors forming the three arms of the fire triangle are detailed. High oxygen concentration in proximity to the surgical field where electrocautery is being used is the most common combination leading to surgical fire accidents. Conclusion: Summary recommendations for the prevention of surgical fires are presented. Preventing the development of an oxidiser-enriched environment is the main risk-reducing measure. Identifying high-risk cases and improving communication between the surgical, anaesthetic and nursing staff who control the arms of the fire triangle are very important measures in avoiding theses catastrophic events.

Surgical fires: Still a burning issue in England and Wales

A significant number of surgical fires occur each year and can have devastating effects on patients. The National Reporting and Learning System database identified 37 reports of surgical fires in England and Wales between January 2012 and December 2018 – over 52% resulting in some degree of harm. Surgical fires remain preventable adverse events that can be avoided by adherence to effective preventative strategies and improved education. This article surveys the existing literature, addressing the fire triad and how to effectively manage and prevent a surgical fire.

Surgical Fires in Otolaryngology: A Systematic and Narrative Review

Objective To bring attention to the epidemiology, prevention, management, and consequences of surgical fires in otolaryngology by reviewing the literature. Data Sources PubMed, EMBASE, Web of Science, and Scopus. Review Methods Comprehensive search terms were developed, and searches were performed from data source inception through August 2016. A total of 4506 articles were identified; 2351 duplicates were removed; and 2155 titles and abstracts were independently reviewed. Reference review was also performed. Eligible manuscripts described surgical fires involving patients undergoing otolaryngologic procedures. Results Seventy-two articles describing 87 otolaryngologic surgical fire cases were identified. These occurred during oral cavity or oropharyngeal procedures (11%), endoscopic laryngotracheal procedures (25%), tracheostomies (36%), “other” general anesthesia procedures (3%), and monitored anesthesia care or local procedures (24%). Oxidizing agents consisted of oxygen alone (n = 63 of 81, 78%), oxygen and nitric oxide (n = 17 of 81, 21%), and room air (n = 1 of 81, 1%). The fractional inspired oxygen delivered was >30% in 97% of surgical fires in non–nitrous oxide general anesthesia cases (n = 35 of 36). Laser-safe tubes were used in only 12% of endoscopic laryngotracheal cases with endotracheal tube descriptions (n = 2 of 17). Eighty-six percent of patients experienced acute complications (n = 76 of 87), including 1 intraoperative death, and 22% of patients (n = 17 of 77) experienced long-term complications. Conclusion Surgical fires in otolaryngology persist despite aggressive multi-institutional efforts to curb their incidence. Guideline recommendations to minimize the concentration of delivered oxygen and use laser-safe tubes when indicated were not observed in many cases. Improved institutional fire safety practices are needed nationally and internationally.