DOI: 10.1097/01.sa.0000235558.41190.f5
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Issn Print: 0039-6206
Publication Date: 2006/10/01
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Excerpt
Samsun Lampotang,*†‡ Nikolaus Gravenstein,*§ David A. Paulus,*† and Dietrich Gravenstein
(Anesth Analg, 101:1407-1412, 2005)
*Department of Anesthesiology, University of Florida College of Medicine; Departments of †Mechanical and Aerospace Engineering and ‡Electrical and Computer Engineering, University of Florida College of Engineering and §Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL.
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has recommended that air or fraction of inspired oxygen (FiO2) at 30% or less be used for open delivery, consistent with the patient's needs, to prevent surgical fires. This can be interpreted to mean that 100% oxygen should not be used indiscriminately, and anesthesia providers should have the ability to deliver sub-100% oxygen with nasal cannulae. Addressing the recommendations poses challenges in terms of altering clinical practice, ensuring safe care for patients, requiring supplemental oxygen equipment, and added cost. These challenges are compounded by the wide variety of designs and configurations of anesthesia machines and clinical practices. This report analyzes equipment and practice recommendations that help prevent surgical fires during routine procedures.
Anesthesia machines with an air flowmeter can blend a sub-100% oxygen mixture in air and deliver it to the common gas outlet and the auxiliary common gas outlet. One approach that does not require a nasal cannula uses a corrugated hose breathing circuit to deliver an FiO2 of 30% or less gas mixture directly from a Y-piece placed close to the patient's nose. A variation is to connect a nasal cannula to the Y-piece of a standard circle breathing circuit and supply the gas blend from the flowmeter bank.
In anesthesia machines without an air flowmeter, N2O should not be used as the balance gas when supplying nasal cannulae with an FiO2 of 30% or less because it may provide unintended analgesia or loss of consciousness, it will contaminate the room, and (similar to oxygen) N2O is an oxidizer and supports combustion. Heliox can be used in machines with a heliox flowmeter, but heliox may be more expensive and supplied in different mixes such as 25% and 40% oxygen.
In anesthesia machines without an air flowmeter, an option is an add-on air/oxygen gas blender, but it has the disadvantages of added expense, plumbing, mounting hardware, and clutter. If a source of compressed medical air is unavailable, an option is to use 100% oxygen from the auxiliary oxygen flowmeter and discontinue oxygen supplementation for at least 60 seconds before and during cautery use or empirically scavenge in the region of the head and neck.
Other approaches to minimize the risk of surgical fires address the fuel and ignition aspects of fires. Generally, removal of fuel components is the responsibility of the nurses, whereas the ignition source is usually under the control of the surgical staff. Anesthesia providers control the oxidizer component. This report focuses on actions under the direct control of the anesthesia providers. A multidisciplinary team effort is necessary to create a redundant safety system that reduces the occurrence of surgical fires.
