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At this year's Euroanaesthesia congress (annual meeting of the European Society of Anesthesiology) in Vienna, Austria (1-3 June), doctors present the unique case of a man who has undergone a flash fire in the thoracic cavity during an urgent cardiac operation caused by oxygen supplement that escapes from a broken lung.
Ruth Shaylor and her colleagues at Austin Health in Melbourne, Australia, where the incident took place, point out that the case highlights the potential dangers of dry surgical packs in the environment oxygen enriched operating room where electrocautery devices (using heat to stop vessels) bleeding) are used.
In August 2018, a 60-year-old man presented for an emergency repair of aortic dissection ascending, a tear of the inner layer of the wall of the aorta in the chest . The patient had a history of chronic obstructive pulmonary disease (COPD) and had undergone coronary artery bypass surgery a year earlier.
When the surgeons began to operate, they found that the right lung of the man was stuck to the overlying sternum, with areas of lungs too inflated and destroyed (bullae, often caused by COPD). Despite careful dissection, one of these bubbles was punctured, causing significant air leakage. In order to prevent respiratory disorders, anesthetic gas flow rates were increased to 10 liters per minute and the proportion of oxygen to 100%.
Shortly after, a spark from the electrocautery device ignited a dry operating room. The fire was immediately extinguished without hurting the patient. The rest of the operation went smoothly and the repair was a success.
"Although there are only a few documented cases of chest cavity fires – three involving thoracic surgery and three involving coronary bypass surgery – all involved the presence of dry surgical packs , electrocautery, increased concentrations of inspired oxygen, and existing pulmonary COPD patients, "says Dr. Shaylor.
"This case highlights the continued need for fire prevention and fire training strategies as well as rapid interventions to prevent injury whenever electrocautery is used in oxygen enriched environments. Surgeons and anesthetists in particular should be aware that fires may occur in the chest cavity if damaged or there is an air leak for any reason, and that patients with COPD are at increased risk. "
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