Surgery Emergency

April 21, 2008 9:26:12 PM PDT
Fire in the operating room has patients, and now some doctors, sounding the alarm.Some patients are going into the OR for "routine surgery" and leaving as burn victims. While most surgeons agree it's rare, some victims believe it's just under-reported. One group of doctors is making recommendations in hopes of avoiding a surgery emergency.

David Hlebasko checked in to a northwest Indiana surgery center last June to have a mole and two cysts removed.

"They started unwrapping my face and I could see the expression on my parents' face," said Hlebasko.

He says he never expected to catch on fire during surgery, and he's filed a proposed complaint seeking damages.

"My eyebrow, my eyelashes, burns across the top of my face, everything was like a bright pink, second-degree burns, and it ended up being third-degree burns on my eye socket," said Hlebasko.

Hlebasko's doctor declined to comment specifically on his case, but in a statement from his office said they keep a variety of fire safety equipment in their operating room and have "detailed protocols" for operating safety. Hlebasko, according to the statement, was the only patient in nine years who suffered burns.

Sixteen-year-old Jessica Williams was burned during a surgery, too. She sued her doctors and hospital and recovered a $400,000 settlement.

"I had a cyst under my right ear, so they said that I needed to have it removed," said Williams. "It was third-degree burns on my nose and my throat and second degree on my face."

Until now, the medical community has considered surgical fires isolated incidents. This week, for the first time, the American Society of Anesthesiologists is issuing an advisory, detailing the scope of the problem.

The group estimates surgical fires may happen as often as four times a week, but doctors and hospitals are not required to report fires that occur in or on a patient, so the actual number of cases is unknown.

"There are three things necessary to create a fire. There has to be oxygen, extra oxygen. There has to be a source of ignition. So in the operating room that would be electrocartery. It could be a laser. And there has to be some kind of fuel, paper drapes or cloth gowns things like that. All of those things are used in almost every operating environment," said Dr. M. Christine Stock.

Stock heads the anesthesiology departments at Northwestern University and Northwestern Memorial Hospital. She says team training will be critical for both preventing and reacting to fires in the OR.

"Some of the team training would also include fire drills, what needs to happen, in what order, who should be doing what," said Stock.

To prevent fires, the advisory suggests, nurses make sure flammable skin preps, like alcohol, are dry before draping. Surgeons should alert anesthesiologists before turning on certain tools, like lasers. Then anesthesiologists should reduce the amount of oxygen being administered if possible.

"My name's Catherine Reuter and I started surgicalfire.org after my mother was burned during a surgical fire in order to help others learn."

The advisory's suggestions are not mandatory and come too late for Catherine Reuter. She now uses her Web site to help inform patients.

"We're just trying to get the word out that these events occur and that they need to be addressed swiftly and quickly," said Reuter.

Patients should note that surgeries around the head and neck, like a tonsillectomy, are riskiest because the electric cutting tools will be used closest to the mouth, where the oxygen is delivered. Advocates suggest patients ask their doctors if they have had training dealing with surgical fires. This advisory will appear in next month's issue of the journal Anesthesiology.

American Society of Anesthesiology --- www.asahq.org
Anesthesiology --- www.anesthesiology.org.
www.surgicalfire.org

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