Open heart surgery is already scary on its own, and when a complication occurs during the operation, you'd expect (and hope!) that the surgeon knows every possible outcome like the back of their hand.
A 60-year-old Australian man underwent a bypass surgery under combined inhaled and intravenous general anaesthesia. So far, nothing out of the ordinary: it's a very regular operation that surgeons are used to. This becomes a textbook case when the right lung of the patient got accidentally pierced and air started to leak. Again, it happens.
To avoid the patient's distress, Dr Ruth Shaylor and her colleagues from Austin Health in Melbourne decided to increase the oxygen to 100%. The problem? The team was also using an electrocautery device, a surgical tool that uses heat to seal wounds. The heat combined with the increased oxygen caused a flash fire in the man's chest cavity.
Basically, the man was set on fire in the middle of the operation.
Not even the first time
As crazy as it's sounds, this isn't even an isolated event. In a press release, Dr Ryth Shaylor said:
While there are only a few documented cases of chest cavity fires — three involving thoracic surgery and three involving coronary bypass grafting — all have involved the presence of dry surgical packs, electrocautery, increased inspired oxygen concentrations and patients with COPD or pre-existing lung disease.
We bet that a surgeon's assistant is much more accustomed to passing a scalpel than a fire extinguisher.
This case highlights the continued need for fire training and prevention strategies and quick intervention to prevent injury whenever electrocautery is used in oxygen-enriched environments. In particular, surgeons and anesthetists need to be aware that fires can occur in the chest cavity if a lung is damaged or there is an air leak for any reason, and that patients with COPD are at increased risk.