A brief historical review of non-anaesthetic causes of fires and explosions in the operating room.

Fires and explosions have occurred in the operating theatre for many years. Flammable inhalation anaesthetic agents were responsible for many incidents in the past, but these are no longer available in many countries. Other causes of fires and explosions still exist in the operating theatre and, from time to time, result in serious and occasionally fatal injury. Flammable gastrointestinal gases have been the cause of injury to patients during gastric surgery, laparoscopy and during examination of the large bowel with electrical instrumentation. Gases formed in the bladder during urological procedures have ignited, causing rupture. Alcohol-based skin cleaning agents have resulted in severe burns to the skin. Equipment used for storage and delivery of oxygen to patients has caused fires in a variety of ways. Adhesive skin drapes have resulted recently in two tragic deaths. The increasing use of laser therapy, particularly in ear, nose and throat surgery, and in oral surgery, has brought about a renewed awareness of the risk of fire. The relevant factors which should be borne in mind and the precautions which should be adopted when laser therapy is to be used in the airway are discussed.