INTRODUCTION Surgical fires are a rare event that still occur at a significant rate and can result in severe injury and death. Surgical fires are fueled by vapor from alcohol-based skin preparations in the presence of increased oxygen concentration and a spark from an energy device. Carbon dioxide (CO2) is used to extinguish electrical fires, and we sought to evaluate its effect on fire creation in the operating room. We hypothesize that CO2 delivered by the energy device will decrease the frequency of surgical fires fueled by alcohol-based skin preparations. METHODS An ex vivo model with 15 × 15 cm section of clipped, porcine skin was used. A commercially available electrosurgical pencil with a smoke evacuation tip was connected to a laparoscopic CO2 insufflation system. The electrosurgical pencil was activated for 2 s at 30 watts coagulation mode immediately after application of alcohol-based surgical skin preparations: 70% isopropyl alcohol with 2% chlorhexidine gluconate (CHG-IPA) or 74% isopropyl alcohol with 0.7% iodine povacrylex (Iodine-IPA). CO2 was infused via the smoke evacuation pencil at flow rates from 0 to 8 L/min. The presence of a flame was determined visually and confirmed with a thermal camera (FLIR Systems, Boston, MA). RESULTS Carbon dioxide eliminated fire formation at a flow rate of 1 L/min with CHG-IPA skin prep (0% vs. 60% with no CO2, p < 0.0001). Carbon dioxide reduced fire formation at 1 L/min (25% vs. 47% with no CO2, p = 0.1) with Iodine-IPA skin prep and fires were eliminated at 2 L/min of flow with Iodine-IPA skin prep (p < 0.0001). CONCLUSION Carbon dioxide can eliminate surgical fires caused by energy devices in the presence of alcohol-based skin preps. Future studies should determine the optimal technique and flow rate of carbon dioxide in these settings.

中文翻译：

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二氧化碳可以消除基于酒精的外科皮肤制剂引起的手术室火灾。

引言 手术火灾是一种罕见的事件，仍然以显着的速度发生，并可能导致严重的伤害和死亡。在氧气浓度增加和能源装置产生火花的情况下，酒精类皮肤制剂产生的蒸汽助长了手术火灾。二氧化碳 (CO2) 用于扑灭电气火灾，我们试图评估其对手术室火灾产生的影响。我们假设能量装置提供的二氧化碳将减少由酒精类皮肤制剂引发的手术火灾的频率。方法 使用具有 15 × 15 cm 剪断猪皮部分的离体模型。将带有排烟尖端的市售电外科手术笔连接到腹腔镜 CO2 吹入系统。应用基于酒精的外科皮肤制剂后，立即以 30 瓦凝固模式激活电外科铅笔 2 秒：70% 异丙醇和 2% 葡萄糖酸氯己定 (CHG-IPA) 或 74% 异丙醇和 0.7% 碘 povacrylex (Iodine -IPA)。通过排烟笔以 0 到 8 L/min 的流速注入 CO2。视觉确定火焰的存在并用热像仪（FLIR Systems，Boston，MA）确认。结果 使用 CHG-IPA 皮肤准备剂时，二氧化碳以 1 L/min 的流速消除了火灾形成（0% 对 60%，不含 CO2，p < 0.0001）。使用碘-IPA 皮肤准备剂时，二氧化碳以 1 L/min 的速度减少火灾形成（25% 对 47%，没有 CO2，p = 0.1），使用碘-IPA 皮肤准备剂以 2 L/min 的流量消除火灾（p < 0.0001)。结论 二氧化碳可以消除在存在酒精类皮肤制剂的情况下由能量设备引起的手术火灾。未来的研究应确定这些环境中二氧化碳的最佳技术和流速。