Culp William C, Kimbrough Bradly A, Luna Sarah, Maguddayao Aris J
From the Department of Anesthesiology, Texas A&M University Health Science Center College of Medicine, Scott & White Hospital, Temple, TX.
Ann Surg. 2014 Aug;260(2):214-7. doi: 10.1097/SLA.0000000000000654.
To reduce the incidence of surgical fires.
Operating room fires represent a potentially life-threatening hazard and are triggered by the electrosurgical unit (ESU) pencil. Carbon dioxide is a fire suppressant and is a routinely used medical gas. We hypothesize that a shroud of protective carbon dioxide covering the tip of the ESU pencil displaces oxygen, thereby preventing fire ignition.
Using 3-dimensional modeling techniques, a polymer sleeve was created and attached to an ESU pencil. This sleeve was connected to a carbon dioxide source and directed the gas through multiple precisely angled ports, generating a cone of fire-suppressive carbon dioxide surrounding the active pencil tip. This device was evaluated in a flammability test chamber containing 21%, 50%, and 100% oxygen with sustained ESU activation. The sleeve was tested with and without carbon dioxide (control) until a fuel was ignited or 30 seconds elapsed. Time to ignition was measured by high-speed videography.
Fires were ignited with each control trial (15/15 trials). The control group median ± SD ignition time in 21% oxygen was 3.0 ± 2.4 seconds, in 50% oxygen was 0.1 ± 1.8 seconds, and in 100% oxygen was 0.03 ± 0.1 seconds. No fire was observed when the fire safety device was used in all concentrations of oxygen (0/15 trials; P < 0.0001). The exact 95% confidence interval for absolute risk reduction of fire ignition was 76% to 100%.
A sleeve creating a cone of protective carbon dioxide gas enshrouding the sparks from an ESU pencil effectively prevents fire in a high-flammability model. Clinical application of this device may reduce the incidence of operating room fires.
降低手术中发生火灾的几率。
手术室火灾是一种潜在的危及生命的危险，由电外科设备（ESU）笔引发。二氧化碳是一种灭火剂，是常用的医用气体。我们推测，覆盖ESU笔尖的保护性二氧化碳气幕能够置换氧气，从而防止起火。
利用三维建模技术制作了一个聚合物套管，并将其连接到ESU笔上。该套管连接到二氧化碳源，使气体通过多个精确成角度的端口，在活动的笔尖周围形成一个灭火二氧化碳锥体。该装置在含有21%、50%和100%氧气的燃烧试验箱中进行评估，持续激活ESU。对有和没有二氧化碳（对照）的套管进行测试，直到燃料被点燃或经过30秒。通过高速摄像测量点火时间。
每次对照试验均引发了火灾（15次试验中有15次）。对照组在21%氧气中的中位±标准差点火时间为3.0±2.4秒，在50%氧气中为0.1±1.8秒，在100%氧气中为0.03±0.1秒。在所有氧气浓度下使用消防安全装置时均未观察到火灾（0/15次试验；P<0.0001）。火灾点火绝对风险降低的确切95%置信区间为76%至100%。
一个能形成保护性二氧化碳气锥以包裹ESU笔产生的火花的套管，在高易燃性模型中能有效防止火灾。该装置的临床应用可能会降低手术室火灾的发生率。
