Chapter 87
- Electrical Safety in the Operating Room
- Lawrence Litt
Technologic advances have led to increased sophistication and
use of electrical equipment in operating rooms throughout the United States. Although
improved alarm systems and safeguards have also been introduced, unsafe electrical
configurations still cause injury during surgery and anesthesia. Tragic events continue
to be reported in the medical literature, illustrating the serious consequences of
inattention to electrical safety. Although the chief dangers have found new ways
to appear, they remain the same: fire, electrical burns, and electrical shocks (i.e.,
macroshock and microshock). The culprit is often surgical equipment by itself or
its unsafe use. However, anesthesia and physiologic monitoring equipment can also
be involved.
Important articles about intraoperative fires have appeared,[1]
[2]
[3]
[4]
[5]
[6]
with logical
approaches based on the three requirements for a fire: oxygen, fuel, and an ignition
source.[5]
Electrical safety issues associated
with operating room fires usually concern ignition, which can be simple, as in the
contact of surgical drapes with electronically generated sparks or high temperatures.
Ignition also can be complex and not immediately understood, as in the case of an
exploding expiratory valve in an anesthetic breathing circuit.[7]
In the operating room, anesthesiologists need to be aware of fire safety concerns,
doing all they can to keep ignition sources away from fuel sources while always able
to identify the location of the nearest fire extinguisher. There should be one in
every operating room!
Severe burns have been caused by inadequate grounding, faulty
equipment, and induced currents from radiofrequency fields. One report describes
a neonate with third-degree burns after application of an external cardiac pacing
device for a prolonged period.[8]
Another report
describes serious burns occurring from the direct electric current (DC) generated
by a 9-volt battery in a small neuromuscular stimulator.[9]
Fortunately, patient electrocution is now uncommon, although it was once a well-recognized
hazard of surgery and the operating room[8]
and
even of hospitalization in general.[11]
[12]
[13]
[14]
Although many types of modern equipment appear different from
their ancestral counterparts, the injuries caused by electricity are similar or identical
to those occurring generations ago. Electrical malfunctions in the operating room
continue to cause fires and explosions, central and peripheral nerve stimulation
and damage, muscle stimulation and contracture, tissue burns, pacemaker interference,
and sudden loss of power to important equipment. Safety standards for medical equipment
have been improving, and most complications can be avoided by preventive maintenance
of equipment, careful attention to the electrical contacts used on patients, and
appropriate responses to alarm signals. Understanding electrical safety is an especially
important responsibility for anesthesiologists because perioperative electrical dangers
can often be identified before they lead to disruption of patient care or to injury.
[15]
[16]
[17]
[18]
[19]
Having described the general situation, we now turn to the essential
details of electrical safety. This discussion is followed by the presentation of
guidelines for safe clinical practice.
