In: Health

15 Sep 2009

FIRE HAZARDS WITH AMBULATORY ANESTHESIA IN THE DENTAL OFFICEAccording to statistics recently released by the American Society of Plastic Surgeons, US surgeons performed more than 8.7 million cosmetic surgical procedures in 2003, an increase of 32% over the previous year. Importantly, 56% of these cases were performed in offices. Many of these procedures were performed on patients under various levels of conscious sedation, deep sedation, and general anesthesia, where supplemental oxygen, often delivered via nasal cannula, is used. For facial surgery, such as rhinoplasty, blepharoplasty, and rhytidectomy, disposable, sterile, paper drapes are typically applied to the head and then draped over much or all of the body to isolate the sterile surgical field. Unfortunately, there have been numerous reports that as the increased oxygen concentration builds up under the drapes surrounding the face, a spark from the electrocautery unit can ignite the drapes, and, in the oxygen-rich atmosphere, they can burst into a ball of flames that can severely burn the patient. Obviously, supplemental oxygen is beneficial, particularly with deep sedation or general anesthesia, to maintain normal oxygenation and to provide a greater margin of safety from hypoxemia should airway difficulties occur. Until the origin of the airway problem can be diagnosed and corrected, the well-oxygenated patient will remain adequately oxygenated for a longer period than if breathing room air. Supplemental oxygen can provide the anesthetist with additional critical seconds to correct the problem before serious morbidity or mortality associated with hypoxemia occurs.

We know that fire requires a source of heat, oxygen, and fuel. Therefore, since electrocautery and supplemental oxygen are both essential to the success of many cosmetic operations, the paper drapes, which are a highly flammable source of fuel for the fire, could be eliminated in favor of moistened, sterile cloth towels to help prevent this type of catastrophe. buy generic levitra

Another source of fire during surgery is associated with sevoflurane and desiccated carbon dioxide absorbents (soda lime or Baralyme) in the anesthesia circuit. It is possible that desiccation may result if the oxygen is inadvertently left flowing after the anesthetic is completed and continues to flow through the machine’s absorbent canister for long periods, such as over a weekend, or if the machine has not been used for an extended period. Most of these fires have been associated with the first case of the day. A change in the color of the carbon dioxide absorbent does not necessarily indicate desiccation. Apparently, the desiccated absorbent and sevoflurane can react, the sevoflurane molecule may break down, and a hot exothermic reaction in the absorbent canister can cause the anesthesia circuit or the sevoflurane breakdown products to ignite. Although exceedingly rare, several of these fires have been reported.

In November 2003, a “Dear Health Care Professional” letter was mailed from Abbott Laboratories, which is also available online. It cautions that the carbon dioxide canister should be monitored periodically for excessive heat and that we should take measures to prevent desiccation of the absorbent, such as turning off all gas flow when the machine is not being used, changing the absorbent regularly, and exercising caution in using potential ignition sources, such as electrocautery in an oxygen-rich environment near sites of potential sevoflurane gas leakage. In the meantime, Abbott Laboratories and the Food and Drug Administration will continue to investigate the causative and preventative factors surrounding this rare event. generic cialis online

Several other fire hazards were recently reported in the March 11, 2004, issue of the Institute of Safe Medical Practices newsletter. Lacri-Lube, which is a petrolatum-based ointment placed in the eyes to prevent corneal abrasions during facial surgery, has ignited when electrocautery was used to remove facial warts near the eyes. Approximately 100 surgical fires happen each year, causing serious injury and death involving flammable products such as alcohol-containing preparations, ointments, and wound dressing products, such as tincture of benzoin or collodion. Even ethyl chloride that is sprayed to freeze or anesthetize the skin before a brief electrocautery for wart removal has ignited into a roaring fire, and according to the material safety data sheet, even a spark from static electricity can ignite ethyl chloride.

With all of these hazards identified and many others still unidentified, it is incumbent on all of us who are involved as surgeons or anesthesia providers to use extreme care whenever supplemental oxygen, heat sources, and flammable materials are in close proximity. It would also seem desirable for all of us to have a fire extinguisher immediately available in the operatory whenever electrocautery, lasers, or other sources of heat are used for patient care. Having an extinguisher at an arm’s length rather than down the hall may critically influence the outcome of a patient who is on fire. buy prevacid

It is often said that familiarity breeds contempt. Let us be even more vigilant to ensure the safety of our patients from these types of devastating fire-related complications.

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Blog invites submissions of review articles, reports on clinical techniques, case reports, conference summaries, and articles of opinion pertinent to the control of pain and anxiety in dentistry.