To the Editor

Figure 1. Skin injury resulting from suction catheter underneath the surgical drapes.

Operating room fires are of great concern to the practicing anesthesiologist. The ECRI Institute estimates that approximately 550 to 600 surgical fires occur each year. The 3 components needed for a fire to occur include 1) an oxidizer, 2) fuel source, and 3) ignition. Some practitioners believe that placing a suction line underneath the drapes may reduce the oxygen content available for sustaining a fire. Is this practice effective/not effective? This could be called sub-hood gas evacuation (SHGE). Theoretically, there may be less oxygen by providing this suction, but this technique does nothing to address the oxygen supply being delivered underneath the drapes. Furthermore, when suction injuries such as these occur on the skin (or when the suction catheter is occluded for any reason), it certainly results in ineffective O₂ evacuation. In this case, there was a mild patient injury related to the usage of suction in this manner (shown in Figure 1). We suggest to APSF readers that if SHGE is applied, then the suction tip should remain visible in order to prevent injuries (most specifically to the skin) related to this technique and maximize potential efficacy.

Dr. George William, MD, FCCP
Dr. Bilal Rana, MD
Dr. Sabeen Mujtaba, MD
University of Texas Medical School
Houston, TX.