Airway fire prevention

Advanced, Clinical Subspecialties

According to the ASA Practice Advisory for the Prevention and Management of OR Fires from 2013, for high-risk procedures (i.e. proximity of an ignition source to an oxidizer-enriched atmosphere), anesthesiologists should collaborate with the procedure team for the purpose of preventing (and managing) a fire:

• Surgeon should be notified whenever there is potential for an ignition source to be in proximity to an oxidizer-enriched atmosphere, or an increase in oxidizer concentration at the surgical site 

• Reduce FiO2 to as low as clinically feasible, as guided by pulse oximetry, and assess reduction by inspired, expired, and/or delivered O2 concentration

• Minimize O2 or nitrous oxide buildup by scavenging operating field with suction

• Avoid nitrous oxide

• For laser surgery, use laser-resistant tubes and fill cuff with saline colored with indicator dye (i.e. methylene blue) as marker for cuff rupture

• For surgery inside airway, use cuffed ETT when possible

• For surgery around face, head, or neck, consider 1) required depth of anesthesia and 2) oxygen dependence. If moderate to deep sedation is required, OR patient exhibits O2 dependence, consider sealed gas delivery device (cuffed ETT or LMA).


    Anesthesiology;2013 Feb;118(2):271-90

    [PubMed: 23287706]

    See also Airway fire mgmt


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Brittany Aeschlimann, MD