A fuel is anything that can burn, including
almost everything that comes in contact with a patient, as well
as the patient himself. Body hair is extremely flammable, particularly
when saturated with oxygen. Furthermore, lanugo, the fine hair covering
most body surfaces and found predominately on the face, is easily
ignited. Once burning, the fire can spread at speeds between two
and ten feet per second.
Another cause for concern is hydrogen and methane.
These gases, which are extremely flammable, are produced by bacteria
in the gastrointestinal tract in quantities of up to 200 ml per
day. Forty percent of these gases are contained in the large bowel.
Flatus contains approximately 44 percent hydrogen and 30 percent
methane. In an environment of at least 5 percent oxygen, hydrogen
can explode at concentrations between 4 percent and 72 percent,
while methane can explode at concentrations between 5 percent and
15 percent. In the colon the concentration of oxygen is approximately
5 percent, but this level is increased when oxygen or nitrous oxide
is administered during anesthesia. Furthermore, patients with medical
conditions requiring operations, such as pyloric stenosis or intestinal
obstruction, commonly have large amounts of gas in their intestines
as a result of stasis and bacterial overgrowth. These gases may
be liberated during abdominal operations due to accidental perforation
of the bowel and can become the fuel
source for intra-abdominal ignition. Such a case was reported
in the January 1992 issue of the ECRI Health Devices.
According to ECRI, during surgery a portion of
the tissue heated by the ESU
turns to gas, some of which — especially those gases evolved
from fatty tissue — will burn, if made hot enough or if mixed
with sufficient oxygen. This information reinforces the need to evacuate
smoke
as close as possible to the surgical site.
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