169 - Pooled Oxygen Concentration and Risk of Oral Surgical Fires

Objectives: Surgical oral fires in the operating room continue to be a detrimental occurrence seen with oral surgeries. Dental surgeries, especially with oxygen supplementation, can create a highly saturated oxygen environment subsequently increasing the likelihood of flame ignition. This study helps gain more insight on how oxygen concentrations reach dangerous levels in order to prevent future surgical fires when delivering supplemental oxygen using an intraoral laboratory based model simulating a patient undergoing moderate or deep sedation.

Methods: An acrylic dome was used to replicate the approximate size of the oral environment of a 10 year old. On this dome, an entrance for an oral cavity was fabricated, as well as two small openings to replicate the nares. Trials either had supplemental oxygen provided at 3L/minute to simulate a procedure with moderate-deep sedation, or no supplemental oxygen given simulating a protected airway with endotracheal intubation. Each trial was 4 minutes total, and the fraction of inspired oxygen (FiO2) was measured throughout the trials every 10 seconds. At 2 minutes, the suction method was turned on and remained on for the last 2 minutes of every trial. FiO2 levels were compared when the high speed dental suction was used versus when the Yankauer surgical suction tip was used.

Results: Findings indicated that oxygen measurements were significantly higher with supplemental oxygen via the nasal cannula than tests completed without supplemental oxygen for both suction methods (p < 0.001). Furthermore, oxygen measurements with supplemental oxygen were significantly lower for high speed dental suction than Yankauer surgical suction (p < 0.001).

Conclusions: These results show a higher risk of oxygen concentrations >21%, or room air, during a simulated dental procedure with moderate sedation with supplemental oxygen than when no supplemental oxygen is given simulating a protected airway with endotracheal intubation. Results also demonstrated that the high speed dental suction is more efficient at reducing oxygen values than the Yankauer surgical suction. Ultimately, this study demonstrates how rapidly oxygen concentrations can reach dangerously high levels in a short time, and how crucial suctioning is at bringing them back down to safe levels regardless of which suction tip is being used.