More 02 During MAC

Albert L. de Richemond, M.S., P.E.; Mark E. Bruley

To the Editor

Regarding the several letters ‘On Supplemental Oxygen during MAC’ printed in your Spring 1993 issue, we applaud the concern about this hazard. In answer to the drape flammability question raised in one of the letters, in oxygen concentrations above 80%, all drape materials can be ignited by lasers and electrosurgical devices and most can be ignited by electrocautery. (See the following: Surgical Drapes. Health Devices 1986 May; 15[51: 111-37. and Laser ignition of surgical drapes. Health Devices 1992 Jan.; 21111: 15-6).

Also, we have investigated fires during head and neck surgery wherein fractional liter per minute flows of oxygen under the drapes were sufficient to enhance the ignitability of the drapes and patient hair. We recommend that, where possible, air rather than supplemental oxygen be used. Tenting of the drapes to allow gas inflow and outflow is also helpful in addition to gas scavenging. These practices and case studies are presented in “Chapter 37-. Head and Neck Surgical Fires’ (in Eisele DW, ed. Complications in head and neck surgery. Mosby, 1993).

In addition, the American Society of Anesthesiologists, at its March 1991 committee meeting on operating room fires, concluded that education of the entire surgical team (i.e., surgeons, anesthesiologists, and nurses) about the fire hazards of surgery is the only practical way of reducing the occurrence of surgical team. It is in that spirit that we send you this letter.

Albert L. de Richemond, M.S., P.E. Senior Project Engineer; Mark E. Bruley, Director Accident and Forensic Investigation Group ECRI

Plymouth Meeting, PA