It’s easy to underestimate the risk of operating room fires, especially as they become less common. Over the last two decades, improved safety protocols have reduced OR fires significantly—from hundreds per year to fewer than a hundred annually. But fewer fires mean fewer reminders, and complacency inevitably creeps in. I call this the ‘pendulum of paranoia’: as incidents decline, vigilance relaxes, creating conditions for fires to return. As an anesthesiologist, I see this dynamic frequently in the OR. Every fire happens to providers who have ‘never had a problem before.’ Maintaining a cautious mindset and proactively adopting clear safety practices can break this cycle—and protect both providers and patients from unnecessary harm.

There are several things that can be done to reduce the likelihood of having a fire in the OR that I rarely see done without my encouragement. Those things include:

Use IV Acetaminophen to Provide Analgesia with Minimal Respiratory Effects

  • Provides analgesia without significant respiratory depression or airway obstruction.
  • Reduces need for narcotics, minimizing sedation-related apnea and airway obstruction.
  • Previously expensive, IV acetaminophen is now available generically at much lower cost—providers should have a clear clinical reason to omit it.

Limit Oxygen Concentration to 30% or Less Using Ventilator Circuit and Mask

  • Effectively reduces fire risk from elevated oxygen concentrations.
  • Securing the face mask with straps can provide adequate seal, comfort and oxygenation without high percentages.

Provide Assisted Breaths with Room Air or Low Oxygen

  • Providers commonly instinctively increase oxygen unnecessarily during low saturation episodes.
  • Assisted breaths at room air or under 30% often suffice to safely correct desaturation.
  • Many anesthesia providers have never tried this and are often surprised by its effectiveness—a genuine blind spot in our training.

Manage Airway Obstruction with Oral or Nasal Airways

  • Oral or nasal airways can often relieve obstruction sufficiently to maintain safe oxygenation at oxygen levels below 30%.

Clearly Discuss and Prepare an Alternative Airway Plan (LMA or Intubation)

  • Essential conversations before starting procedures ensure preparedness for unanticipated difficulties.
  • Ensures both patient and proceduralist understand and anticipate potential changes in airway management.