Skip to main content
PMC home page
Annals of The Royal College of Surgeons of England logoLink to Annals of The Royal College of Surgeons of England
. 2001 Nov;83(6):376–380.

Airway fire during tracheostomy: prevention strategies for surgeons and anaesthetists.

M L Rogers 1, R W Nickalls 1, E T Brackenbury 1, F D Salama 1, M G Beattie 1, A G Perks 1
PMCID: PMC2503679  PMID: 11777128

Abstract

Airway fires are an uncommon but real and devastating complication of tracheostomy. One such fire in a 31-year-old man is described. Surgical fires are discussed, and 15 reported cases of tracheostomy fire are reviewed. A tracheostomy protocol, adopted by our department and designed to avoid this life-threatening complication, is described. Surgeons and anaesthetists involved in tracheostomy must understand the fire hazard and how to avoid it.

Full text

PDF
376

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aly A., McIlwain M., Duncavage J. A. Electrosurgery-induced endotracheal tube ignition during tracheotomy. Ann Otol Rhinol Laryngol. 1991 Jan;100(1):31–33. doi: 10.1177/000348949110000105. [DOI] [PubMed] [Google Scholar]
  2. Axelrod E. H., Kusnetz A. B., Rosenberg M. K. Operating room fires initiated by hot wire cautery. Anesthesiology. 1993 Nov;79(5):1123–1126. doi: 10.1097/00000542-199311000-00031. [DOI] [PubMed] [Google Scholar]
  3. Bailey M. K., Bromley H. R., Allison J. G., Conroy J. M., Krzyzaniak W. Electrocautery-induced airway fire during tracheostomy. Anesth Analg. 1990 Dec;71(6):702–704. doi: 10.1213/00000539-199012000-00022. [DOI] [PubMed] [Google Scholar]
  4. Baur D. A., Butler R. C. Electrocautery-ignited endotracheal tube fire: case report. Br J Oral Maxillofac Surg. 1999 Apr;37(2):142–143. doi: 10.1054/bjom.1997.0095. [DOI] [PubMed] [Google Scholar]
  5. Bowdle T. A., Glenn M., Colston H., Eisele D. Fire following use of electrocautery during emergency percutaneous transtracheal ventilation. Anesthesiology. 1987 May;66(5):697–698. doi: 10.1097/00000542-198705000-00021. [DOI] [PubMed] [Google Scholar]
  6. Brechtelsbauer P. B., Carroll W. R., Baker S. Intraoperative fire with electrocautery. Otolaryngol Head Neck Surg. 1996 Feb;114(2):328–331. doi: 10.1016/S0194-59989670197-3. [DOI] [PubMed] [Google Scholar]
  7. Chee W. K., Benumof J. L. Airway fire during tracheostomy: extubation may be contraindicated. Anesthesiology. 1998 Dec;89(6):1576–1578. doi: 10.1097/00000542-199812000-00040. [DOI] [PubMed] [Google Scholar]
  8. Coulson A. S., Bakhshay S. A. Harmonic scalpel prevents tracheotomy fires. Chest. 1998 Jul;114(1):349–350. doi: 10.1378/chest.114.1.349-a. [DOI] [PubMed] [Google Scholar]
  9. Hardee P. Re: Baur & Butler. Electrocautery-ignited endotracheal tube fire: case report. Br J Oral Maxillofac Surg. 1999 Oct;37(5):422–422. [PubMed] [Google Scholar]
  10. Hayes D. M., Gaba D. M., Goode R. L. Incendiary characteristics of a new laser-resistant endotracheal tube. Otolaryngol Head Neck Surg. 1986 Jul;95(1):37–40. doi: 10.1177/019459988609500109. [DOI] [PubMed] [Google Scholar]
  11. Hermens J. M., Bennett M. J., Hirshman C. A. Anesthesia for laser surgery. Anesth Analg. 1983 Feb;62(2):218–229. [PubMed] [Google Scholar]
  12. Le Clair J., Gartner S., Halma G. Endotracheal tube cuff ignited by electrocautery during tracheostomy. AANA J. 1990 Aug;58(4):259–261. [PubMed] [Google Scholar]
  13. Lew E. O., Mittleman R. E., Murray D. Endotracheal tube ignition by electrocautery during tracheostomy: case report with autopsy findings. J Forensic Sci. 1991 Sep;36(5):1586–1591. [PubMed] [Google Scholar]
  14. Lim H. J., Miller G. M., Rainbird A. Airway fire during elective tracheostomy. Anaesth Intensive Care. 1997 Apr;25(2):150–152. doi: 10.1177/0310057X9702500208. [DOI] [PubMed] [Google Scholar]
  15. MacDonald A. G. A short history of fires and explosions caused by anaesthetic agents. Br J Anaesth. 1994 Jun;72(6):710–722. doi: 10.1093/bja/72.6.710. [DOI] [PubMed] [Google Scholar]
  16. Macdonald A. G. A brief historical review of non-anaesthetic causes of fires and explosions in the operating room. Br J Anaesth. 1994 Dec;73(6):847–856. doi: 10.1093/bja/73.6.847. [DOI] [PubMed] [Google Scholar]
  17. Mandych A., Mickelson S., Amis R. Operating room fire. Arch Otolaryngol Head Neck Surg. 1990 Dec;116(12):1452–1452. doi: 10.1001/archotol.1990.01870120098019. [DOI] [PubMed] [Google Scholar]
  18. Marsh B., Riley R. H. Double-lumen tube fire during tracheostomy. Anesthesiology. 1992 Mar;76(3):480–481. doi: 10.1097/00000542-199203000-00034. [DOI] [PubMed] [Google Scholar]
  19. Michels A. M., Stott S. Explosion of tracheal tube during tracheostomy. Anaesthesia. 1994 Dec;49(12):1104–1104. doi: 10.1111/j.1365-2044.1994.tb04383.x. [DOI] [PubMed] [Google Scholar]
  20. Schramm V. L., Jr, Mattox D. E., Stool S. E. Acute management of laser-ignited intratracheal explosion. Laryngoscope. 1981 Sep;91(9 Pt 1):1417–1426. [PubMed] [Google Scholar]
  21. Shapiro J. D., el-Baz N. M. N2O has no place during oropharyngeal and laryngotracheal procedures. Anesthesiology. 1987 Mar;66(3):447–448. doi: 10.1097/00000542-198703000-00052. [DOI] [PubMed] [Google Scholar]
  22. Simpson J. I., Wolf G. L. Endotracheal tube fire ignited by pharyngeal electrocautery. Anesthesiology. 1986 Jul;65(1):76–77. doi: 10.1097/00000542-198607000-00012. [DOI] [PubMed] [Google Scholar]
  23. Sosis M. B., Braverman B. Prevention of cautery-induced airway fires with special endotracheal tubes. Anesth Analg. 1993 Oct;77(4):846–847. [PubMed] [Google Scholar]
  24. Sosis M. B., Dillon F. X. Saline-filled cuffs help prevent laser-induced polyvinylchloride endotracheal tube fires. Anesth Analg. 1991 Feb;72(2):187–189. doi: 10.1213/00000539-199102000-00008. [DOI] [PubMed] [Google Scholar]
  25. Stouffer D. J. Fires during surgery: two fatal incidents in Los Angeles. J Burn Care Rehabil. 1992 Jan-Feb;13(1):114–117. [PubMed] [Google Scholar]
  26. Sudhindra T. V., Joseph A., Hacking C. J., Haray P. N. Are surgeons aware of the dangers of diathermy? Ann R Coll Surg Engl. 2000 Jan;82(1):31–32. [PMC free article] [PubMed] [Google Scholar]
  27. Thompson J. W., Colin W., Snowden T., Hengesteg A., Stocks R. M., Watson S. P. Fire in the operating room during tracheostomy. South Med J. 1998 Mar;91(3):243–247. doi: 10.1097/00007611-199803000-00005. [DOI] [PubMed] [Google Scholar]
  28. Waldron J., Padgham N. D., Hurley S. E. Complications of emergency and elective tracheostomy: a retrospective study of 150 consecutive cases. Ann R Coll Surg Engl. 1990 Jul;72(4):218–220. [PMC free article] [PubMed] [Google Scholar]
  29. Wilson P. T., Igbaseimokumo U., Martin J. Ignition of the tracheal tube during tracheostomy. Anaesthesia. 1994 Aug;49(8):734–735. doi: 10.1111/j.1365-2044.1994.tb04419.x. [DOI] [PubMed] [Google Scholar]
  30. Wolf G. L., Sidebotham G. W. Endotracheal tube fire: comments on the advisability of not extubating. Anesthesiology. 1999 Sep;91(3):888–889. doi: 10.1097/00000542-199909000-00050. [DOI] [PubMed] [Google Scholar]
  31. Wolf G. L., Sidebotham G. W., Stern J. B. Intraluminal flame spread in tracheal tubes. Laryngoscope. 1994 Jul;104(7):874–879. doi: 10.1288/00005537-199407000-00018. [DOI] [PubMed] [Google Scholar]
  32. Wolf G. L., Simpson J. I. Flammability of endotracheal tubes in oxygen and nitrous oxide enriched atmosphere. Anesthesiology. 1987 Aug;67(2):236–239. doi: 10.1097/00000542-198708000-00014. [DOI] [PubMed] [Google Scholar]
  33. Wood D. E. Tracheostomy. Chest Surg Clin N Am. 1996 Nov;6(4):749–764. [PubMed] [Google Scholar]

Articles from Annals of The Royal College of Surgeons of England are provided here courtesy of The Royal College of Surgeons of England

RESOURCES