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We all know that surgery carries risks, but we did not think that catching fire was one of them. And yet, that's exactly what happened to a man undergoing cardiac surgery in Australia.
The 60-year-old patient was undergoing an emergency procedure under general inhalation and intravenous anesthesia combined to repair a small tear in his aorta – the main blood vessel that carries blood between the heart and the rest of the body.
But there was a complication. The patient, who had previously been treated for lung disease in another hospital, had an enlarged right lung, with several permanent air sacs known as bubbles.
The lung was stuck to his sternum, which the surgeons had to pierce to reach his heart. Despite all their efforts, they punctured one of the bubbles in the lungs and air began to flow.
To remedy this, the flow rate of oxygen in the anesthetic inhaler was increased by 100%. But apparently, it was a major leak: doctors were able to feel the sevoflurane anesthetic that seeped into the patient's lungs.
This sevoflurane was now mixed with a high concentration of highly oxidizing oxygen, making the conditions volatile.
But a fire does not start from nowhere, even when such gases escape the patient.
This is where the last unlucky ingredient comes in: the team also used an electrocoagulation device, a surgical tool that uses heat to seal (or cauterize) wounds.
Apparently, the device was sitting a little too close to a dry surgical bag near the patient's chest. When a spark from the electrocautery device landed on the dry surgical bag in highly oxygenated air, the whole thing caught fire.
Although the event is unusual, it is not the first time that this occurs in a patient. Previously, seven other cases reported detailed cases of fires in the thoracic cavity during the surgical procedure, three of which involved thoracic surgery and the remaining four during a surgical bypass.
All had the same elements in common. A patient with underlying lung disease. Electrocautery devices. Dry surgical pouches. An increased flow of oxygen in the anesthetic.
Doctors believe that it is a combination that surgeons must know and take with the utmost care.
Meanwhile, the patient was doing well and – like the previous seven patients – came out unscathed from his fiery experience.
The fire was "immediately extinguished without the patient being hurt," doctors said at the Euroanaesthesia Congress in Vienna.
"The rest of the operation went off without incident and he had a successful unplugged repair of his ascending aorta and arch."
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