As anesthesiologist Carol A. Hirshman, MD, found out nearly 25 years ago, the risk of OR fires is present whenever and wherever surgery is performed. "One of the scariest things to happen to me in an OR," is how Dr. Hirshman describes the moment the cuff of the tube exploded and an airway fire broke out during a routine CO2 laser removal of papilloma lesions from a teenage boy's throat. "It was wrapped with foil, but somehow the inside of the tube caught fire and burned."

The boy would recover, but the incident still haunts Dr. Hirshman. "It was very fortunate that the child was all right. Awareness is the key. You have to make sure people understand that [surgical fires] are a possibility. Once you know, you can be more careful," she says.

Just last month, Abbott Laboratories sent 50,000 anesthetists a letter warning of possible fire or extreme heat in the respiratory circuit of anesthesia machines when Ultane (sevoflurane) is used with a desiccated CO2 absorbent (see "Fires Prompt Warning, Ultane Label Change" on page 12).

A hundred or so surgical fires occur annually, estimates ECRI, a health-services research agency in Plymouth Meeting, Pa. The most common ignition sources for surgical fires are electrosurgery (68 percent), cautery (hot wire), light sources and bur sparks(19 percent), and laser (13 percent). Surgical fires most often occur in the airway (34 percent) or in the face, head, neck and chest (28 percent). Thirty years ago, when such flammable anesthetic gases as ether or cyclopropane were used for surgery, fire precautions were commonplace. Prevention methods included maintaining proper humidity in the OR to prevent static buildup, and using anti-static surgical-table mat covers and anesthetic gas scavenging systems that trap and dispose of exhaled gases.