To the Editor:—

In the recent article by Grief et al. , 1the authors state that the use of extra oxygen during and after surgery to ease anesthesia-induced nausea is “essentially risk-free.” We take exception to that statement; the use of extra oxygen during surgery is not risk free.

When extra oxygen is used during surgery, the risk of surgical fire increases. This finding is often overlooked, to the dismay of the surgical team and the injury or death of the patient. We have investigated and consulted about scores of airway fires, head and neck surgery fires, and fires during general anesthesia in which an oxygen-enriched atmosphere directly contributed to the fire. We urge anesthesiologists to use extra oxygen during surgery cautiously and only with the understanding of the entire operating team that, with the extra oxygen, there is an increased risk of surgical fire.

Please refer to the attached short reference section for further details regarding surgical fires and the hazards of oxygen-enriched atmospheres. 2–21There are many more published articles about surgical fires than the few listed herein; however, these citations are among the most noteworthy of the published information about surgical fires, and they provide much of the background and detail about the prevention of surgical fires.

Grief R, Laciny S, Rapf B, Hickle R, Sessler D: Supplemental Oxygen Reduces the Incidence of Postoperative Nausea and Vomiting. A nesthesiology 1999; 91:1246–52
Bennett JA, Agree M: Fire in the chest (letter). Anesth Analg 1994; 78:406
Bruley ME, Lavanchy C: Oxygen-enriched fires during surgery of the head and neck, Symposium on Flammability and Sensitivity of Material in Oxygen-enriched Atmospheres, Vol. 4. Edited by Stoltzfus JM, Benz F, Stradling J. Philadelphia, American Society for Testing and Materials, 1989, pp 392–405
de Richemond AL, Bruley ME: Insidious iatrogenic oxygen-enriched atmospheres as a cause of surgical fires, Flammability and Sensitivity of Materials in Oxygen-enriched Atmospheres. Vol. 6. Edited by Janoff DD, Stolzfus JM. Philadelphia, American Society for Testing and Materials, 1993, pp 66–73. ASTM STP 1040
de Richemond AL, Bruley ME: Head and neck surgical fires, Complications in Head and Neck Surgery. Edited by Eisele DW. St. Louis, Mosby Year Book, 1992, pp 492–508
Dorsch JA, Dorsch SE. Hazards of anesthesia machines and breathing systems, Understanding Anesthesia Equipment, 3rd edition. Baltimore, Williams & Wilkins, 1999, pp 345–7
ECRI: OR fires: Preventing them and putting them out. Health Devices 1986; 15(5):132
ECRI:“The patient is on fire!” A surgical fires primer. Health Devices 1992; 21(1):19–34
ECRI: Fires from defibrillation during oxygen administration (hazard). Health Devices 1994; 23(7):307–9
ECRI: Fires from oxygen use during head and neck surgery (hazard). Health Devices 1995; 24(4):155–7
ECRI: Electrosurgical airway fires still a hot topic (hazard). Health Devices 1996; 25(7):260–2
Galapo S, Wolf GL, Sidebotham GS: Laser ignition of surgical drapes in an oxygen enriched atmosphere (abstract). A nesthesiology 1998; 89:A580.
Greco RJ, Gonzalez R, Johnson P, Scolieri M, Rekhopf PG, Heckler F: Potential dangers of oxygen supplementation during facial surgery. Plast Reconstr Surg 1995; 95 (6):978–84
Hirschman CA, Smith J: Indirect ignition of the endotracheal tube during carbon dioxide laser surgery. Arch Otolaryngol 1980; 106:639–41
Lavy EI: Explosions during lower bowel electrosurgery. Am J Surg 1954; 88:754–8
MacDonald AG: A brief historical review of non-anaesthetic causes of fires and explosion in the operating room. Br J Anaesth 1994; 73:847–56
National Fire Protection Association: NFPA 99 standard for health care facilities. Quincy, Massachusetts, National Fire Protection Association (NFPA), 1996
Neufeld GR: Fires and explosions, Complications in Anesthesiology. Edited by Gravenstein N, Kirby RK. Philadelphia, J.B. Lippincott, 1996, pp 73–8
Reyes RJ, Smith AA, Mascaro JR, Windle BH: Supplemental oxygen: ensuring its safe delivery during facial surgery. Plast Reconstr Surg 1995; 5:924–8
Stouffer DJ: Fires during surgery: two fatal incidents in Los Angeles. J Burn Care Rehab 1992; 13:114–7
Wolf GL, Simpson JI. Flammability of endotracheal tubes in oxygen and nitrous oxide enriched atmosphere. A nesthesiology 1987; 67:236–9