ASOPRSFall Scientific SymposiumSyllabus
39
EyelidSession
Moderator: EricA. Steele,MD
8:05 am
Reducing theRiskofOperatingRoomFires inEyelidSurgerywith aMixtureof
Medical Air andOxygen viaNasal Cannula
CharlesRice
1,2
,Michael Twilley
2
.
1
LansingOphthalmology, East Lansing,MI, UnitedStates,
2
MichiganSurgical Center, East Lansing,
MI, UnitedStates
Introduction:
This study applies research of major disasters towards the prevention of operating room fires and offers amethod to
reduce the oxygen level delivered at the nasal cannula.
Methods:
Ten adult patients undergoing functional eyelid surgery under conscious sedationwere included in the study.The standard
3-gas (air, nitrous oxide, and oxygen) anesthesiamachinewasmodifiedwith adapters to deliver amixture of oxygen andmedical
air via a Salter style nasal cannula tomaintain a delivered oxygen level below30% during the surgical period.The nasal cannula
delivered 25% oxygen concentrationwithmedical air set at 4 liters/min. and oxygen at 50ml/min. (minimum flow). Patient’s oxygen
saturation and oxygen level at the nasal cannulawere recorded during surgery.
Results:
Therewere 7males and 3 females ranging from 59 to 88 years of age (average 64 years of age).The oxygen concentration
delivery from the start to the end of surgery ranged from22-26% (average 23% ) with oxygen saturations between 94-98% (average
96%).Anesthesia communicated the levels of oxygen delivery at the start of surgery and during the case.The surgeon reportedwhen
therewas cautery activation and cessation.
Conclusions:
The study of catastrophes such as airline crashes, nuclear accidents, and space shuttle disasters demonstrate
that a series of mechanical and human errors lead to the tragic event rather than a single isolated factor.
1,2
Comparably, oxygen
operating room fires occur frommultiple factors such as lack of communication between anesthesia and surgeons aswell as
failure to recognize risks of oxygen levels, heat of ignition source, and fuel sources. Rather than accountablemembers functioning
independently, the team approach involves the responsibility and communication between surgeons, anesthesia providers, nursing,
and technical staff.
3
Most oculoplastic procedures are at an increased risk of operating room fire due to the proximity of cautery
near nasal cannula oxygen delivery.
4,5
Oxygen concentrations above 25% increase the rate of combustion over room air. If oxygen
concentration at the nasal cannula can bemeasured, communicated, andmaintained below25%while providing adequate
oxygenation, then one of themajor risks of operating room fires can be diminished.
References:
1. Perrow, C. Normal Accidents:Livingwith
High RiskTechnologies. NewYork. Basic Books. 1984
2. Gladwell,M. Outliers,The Story of Success. NewYork.
Little, Brown, andCo. 2008
3.American Society of Anesthesiologists: PracticeAdvisory
for the prevention andmanagement of operating room fires.
Anesthesiology. 2013;118:1-20
4. Orhan-SungurM, Komatsu R, ShermanA, et. al.
Effect of nasal cannula oxygen administration on oxygen
concentration at facial and adjacent landmarks.Anaesthesia
2009, 64: 521-526
5. Greco RJ, Gonzalez R, Johnson P, Scolieri M, et. al.
Potential dangers of oxygen supplementation during facial surgery.
Plastic and Reconstructive Surgery 1995:95:978-84
DetailedProgram
—Thursday,October 16, 2014
