Electrocautery-induced ignition of tonsillar packing.

Abstract

A recent case of ignition of a bismuth-subgallate pack during routine tonsillectomy prompted this investigation of local oxygen levels. Similar conditions were reproduced in the laboratory to determine their influence on the flammability of materials commonly used to aid in haemostasis. Cotton tonsil packs soaked in saline, adrenalin, or adrenalin and bismuth were compared. During spontaneous ventilation through an age-appropriate uncuffed endotracheal tube, an air leak rarely occurred. However, when assisted ventilation was used, an airway leak produced an elevated oxygen concentration in 8 of 10 children. This was associated with increased combustibility of the packs, regardless of solution mixture. The addition of bismuth further increased combustibility. Partially saturated packs appeared to be more combustible than fully saturated packs.