Flash Fires during Facial Surgery

Sir: In their communication entitled “Flash Fires during Facial Surgery: Recommendations for the Safe Delivery of Oxygen” (Plast. Reconstr. Surg. 119: 1982, 2007), Rosenfield and Chang claim that in “nonintubated patients undergoing facial surgery, supplemental oxygen is most commonly delivered via nasal cannula.” However, they give no reference to support this statement. Perhaps it is their habit to do this. However, it is not necessary. In the past 30 years, I have performed more than 30,000 plastic surgery procedures, from head to toe, including rhinoplasty, face lift, brow lift, eyes, nose, chin, neck, and liposuction from head to toe, and I have never used supplemental oxygen. The authors then cite five other cases of operating room fires in which oxygen was used. In the interest of patient safety, why not eliminate the common denominator: oxygen? If safe sedation is used with Valium and ketamine,1 or with an anesthesiologist, propofol, and ketamine,2 supplemental oxygen is rarely required. At that time when a fire might occur, surgery should be stopped and, of course, the electric cautery should be turned off before the oxygen is ever turned on. Robert A. Ersek, M.D. 630 West 34th Street, Suite 201 Austin, Texas 78705 [email protected]