Version June 2024
| Limit oxygen administration and concentration Avoid nitrous oxide | Manage fuels | Manage ignition sources |
| Avoid or discontinue open delivery of oxygen (eg, via face mask or nasal cannula) when possible. | Allow prep solutions to dry for at least three minutes. | Avoid an ignition source (eg, ESU or laser) when possible. |
| If use of an open oxygen delivery system is necessary to maintain adequate oxygenation, use an oxygen blender or anesthesia machine to ensure the oxygen concentration is ≤30% before using any ignition source. | Configure surgical drapes to minimize accumulation of oxygen under the drapes. | Use an alternative to a monopolar ESU that does not create sparks (eg, bipolar-tip ESU, harmonic scalpel). |
| Flush the field with room air if feasible, or scavenge the surgical field with suction to minimize oxygen buildup. | Clear the surgical field to remove ignitable organic material. | Give adequate notice (three to five minutes) before use of any ignition source to ensure reduction of oxygen concentration to ≤30%. |
| If adequate oxygenation cannot be maintained with oxygen concentration ≤30% via an open delivery system, convert to a closed oxygen delivery system by securing the airway with an ETT or SGA device. | Use wet surgical sponges and towels. | Use the lowest ESU setting possible. |
| Avoid nitrous oxide | Have a bulb syringe full of sterile water or saline readily available. | |
| Special precautions during airway surgery | ||
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