Anesthesia Considerations 

Airway Fire

 

 

Management

 

• Inform team & call for help

• Simultaneously remove the endotracheal tube (ETT) & stop gases/disconnect circuit

• Pour saline or water into airway

• Remove airway foreign bodies (ie: ETT pieces, sponges)

• When fire is extinguished: re-establish ventilation; avoid supplemental oxygen if possible

• Consider prompt reintubation prior to swelling & coordinated with bronchoscopy

• Examine entire airway (including bronchoscopy) to assess injury & remove residual debris

 

 

Prevention

 

• For high risk procedures:

  • Discuss fire prevention & management with team during time-out

  • Avoid FiO2 > 0.3 & avoid N2O

• For laser surgery of vocal cord or larynx:

  • Use laser resistant ETT (single or double cuff)

  • Assure ETT cuff sufficiently deep below vocal cords

  • Fill proximal ETT cuff with methylene blue-tinted saline (acts as a marker if cuff perforated by laser)

  • Ensure laser in STANDBY when not in active use

  • Surgeon protects ETT cuff with wet gauze

  • Surgeon confirms FiO2 < 0.3 & no N2O prior to laser use (may require several minutes to dilute FiO2 & FeO2 to <0.3 depending on fresh gas flow & initial FiO2)

• For non-laser surgery in oropharynx:

  • Regular PVC ETT may be used

  • Consider packing wet gauze around ETT to minimize O2 leakage

  • Consider continuous suctioning of the operating field inside oropharynx