Operating room fires are rare but devastating events. Guidelines are available for the prevention and management of surgical fires; however, these recommendations are based on expert and case series. The three components of an operating room fire are present in virtually all surgical procedures: an oxidizer (oxygen, nitrous oxide), an ignition source (i.e., laser, “Bovie”), and a fuel. This review analyzes each fire ingredient to determine the optimal clinical strategy to reduce the risk of fire. Surgical checklists, team training, and the specific management of an operating room fire are also reviewed.
When there is suspicion of a fire by any member of the team, the surgery should be stopped immediately. Rapid identification is key and can be problematic with alcohol-based prep fires as they exhibit a light blue flame that is difficult to visualize alongside blue surgical drapes. Besides the obvious heat and smoke, fires may also be preceded by unusual sounds, odors, or patient complaints. Once a fire is identified, the following tasks should be performed almost simultaneously by all members of the operating room team71
Stop the flow of all airway gases and disconnect the breathing circuit.. For airway fires, remove the ETT and pour saline in the airway.
Remove all burning and burned materials from the patient.
Extinguish the fire on the burning material.
Care for the patient.
- a. Restore breathing with room air.