Practical policy for non-explosive anaesthesia.

IN THEm CONSTANT STRUGGLE to reduce morbidity and mortality, anaesthesiologists have tended to overlook the ever-present hazards of fire and explosion. This undoubtedly stems from the low reported incidence of explosion (1:100,0001), which contributes to a tendency among practitioners to consider it a negligible risk. There are other factors. Among them is the "it can't happen here" syndrome. Another is the continued desire among anaesthetists to use and teach the traditional (and familiar) techniques involving ether, cyclopropane, vinyl ether, ethyl chloride, and ethylene. Pervading all these is the problem of enforcing the necessary safety regulations affecting one's colleagues as well as the nurses, doctors, and hospital engineers. As a result, a few of the more simple requirements are stringently met while a general laissez-faire attitude prevails. The purpose of this paper is to explain how the practical problems associated with the introduction of non-explosive anaesthesia can be solved. Although many precautions have always been taken at the Hospital for Sick Children to prevent a fire or explosion in the operating room, no over-all plan for explosion safety existed until July 1960, when a Fire and Explosion Hazards Committee was appointed by, and made responsible to, the Hospital Director. This committee was under the chairmanship of the chief of anaesthesia, and included representatives from surgery, nursing, engineering, and administration. Its terms of reference were to study, formulate, unify, and control all measures that would minimize the hazard of explosion in the operating rooms. 2 The committee met monthly over the next three and one-half years. It concentrated its attention on two key areas: (a) equipment and supplies, and (b) technique and procedures. Among the supplies and equipment introduced were: satisfactory bootees (after 15 types had been tested); numerous conveniently located conductive meters; improved conductive flooring and wall meters; fully conductive anaesthetic apparatus and drag chains on all operating room equipment. Included in the regulations for safe technique and procedure were: adequate instruction to all personnel, covering satisfactory clothing and measures for personal conductivity; daily cheeks on humidity; grounding and labelling of explosion-proof (safe) equipment; plus regular engineering checks on all operating rooms and instructions on the posting of notices regarding entry when an anaesthetic is in use. In addition, great emphasis was placed on the value and use of non-explosive anaesthetics. Despite constant major effort to maintain all the proper precautions, it was