a) Fires in the operating room are a relatively rare event. The classic fire triangle requires the presence of three elements: fuel, an ignition source, and an oxidizing agent (gas that supports combustion).

b) Of the approximately 100 surgical fires reported each year, approximately 20 cause major thermal injuries; however, one to two of these fires result in death.

c) The most common locations of these fires are in the airway (34%), about the head or face (28%), and several other areas of or in the patient’s body (38%).

d) The most common ignition sources are electrosurgical equipment (68%) and lasers (13%). High-intensity light cords have also been reported to be a source of ignition.

e) Fuels commonly found in the operating room consist of alcohol, solvents, sheets and drapes (cloth and disposable paper), and plastic or rubber materials (including endotracheal tubes [ETTs]).

f) Oxygen is by far the most common oxidizing agent, although nitrous oxide can also support combustion. Materials that are only marginally combustible in air can produce a massive flame in the presence of high oxygen concentration.

a) The risk of ignition of combustible materials is progressively increased as oxidizing agents build in the operating room.

b) Oxygen levels should be kept as low as can be safely done, and leaks to the ambient air should be kept to a minimum, with special attention to oxygen and nitrous oxide leaks from the anesthesia mask and nasal cannula.

c) Providers should reduce the oxygen concentration when a heat-producing device, such as a cautery unit or fiberoptic light source, is used. Although fiberoptic light is often called “cool light,” heat is generated.

d) When an open oxygen source is used, excessive oxygen can accumulate under the patient drape or about the operative site creating an enriched oxygen environment. If a spark is created in these areas, a flash fire can rapidly spread out of control.