Editors Page: A Reminder About Surgical Airway Fires

What do you see in this photograph: surgical smoke, right? This photo accompanied an article in last month’s issue about mandatory smoke evacuation legislation. But a reader wrote to let us know he saw flames of fire, not rings of smoke. Where we saw plume, he saw doom. “I was shocked to see the source of ignition that close to a nasal cannula presumably supplying oxygen to a patient,” says anesthesiologist Steven J. Sperring, MD, medical director of the Centennial Surgery Center in Nashville, Tenn. “This is a potentially disastrous situation and one which would be difficult to defend in the case of a surgical airway fire.”

We can only hope that the cannula wasn’t delivering oxygen when this picture was taken. As Dr. Sperring said, it would literally be like playing with fire for oxygen to flow freely while, just a few centimeters away, the Bovie was activated.

“I’m extremely wary of a source of ignition so close to an oxygen source,” he says when we spoke by phone.

Dr. Sperring might be more sensitive than most to the dangers of surgical fires. In 2008, a year before Dr. Sperring’s arrival at Centennial, records show that iconic country music singer Tanya Tucker suffered an airway fire while undergoing a facial peel with laser at the surgery center. Apparently, the oxygen, a fire hazard in the presence of lasers, was not discontinued when the surgeon activated the laser to Ms. Tucker’s eyelids.

Ms. Tucker suffered second- and third-degree facial burns. Flames burned her nostrils and nasopharynx. She filed a lawsuit, in which she claimed the fire made it difficult for her to reach certain notes.

“They caught the laser on fire with the oxygen,” said Ms. Tucker in a release. “The only thing I remember hearing is, ‘Get the ambulance, we’ve got a fire.’ It was the worst thing. I was just saying, ‘God, why me?’”

Dr. Sperring says it’s worth noting the dangers of airway fires with lasers when you don’t have a closed airway.

“Any source of ignition in an airway that’s not a closed circuit is a no-no,” he says. “You don’t want a free-flowing source of oxygen and raised oxygen levels around a source of ignition.” As a reminder when you’re using an open gas delivery device (face mask or nasal cannula, for example), Dr. Sperring cites guidelines from the American Society of Anesthesiologists (ASA) that state that before activating an ignition source around the face, head or neck, the surgeon should give the anesthesia provider adequate notice that he is about to activate the ignition source.

The anesthesia provider should then stop the delivery of supplemental oxygen — or reduce the delivered oxygen concentration to the minimum required to avoid hypoxia — and wait a few minutes after reducing the oxidizer-enriched atmosphere before approving the activation of the ignition source, per the ASA guidelines.

And one thing more. “If I were educating people about airway fires,” says Dr. Sperring, “I would use this photo to tell them this is what not to do.”

Spoken like an anesthesiologist who can sense danger before it happens. OSM