Electrosurgical quality assurance: the view from the OR table

Because of the potential hazards involved in electrosurgery, a number of tasks must be performed by the clinical staff when an electrosurgical unit is used. The tasks can be broken down into three groups--those that must be carried out before commencing with the electrosurgical procedure, those that must be checked during the course of the procedure, and those that must be attended to at the end of the procedure. The author recommends preparing a checklist to ensure proper completion of these tasks, to enhance the safety and efficacy of the ESU.

Complications in colonoscopy

Colonoscopy, when performed for appropriate indications and by experienced, competent personnel, is a remarkably safe procedure. The occasional complications which occur may be the result of pneumatic, mechanical or electrical injuries to the colon or may develop as secondary disorders involving other organ systems. Most complications can be successfully prevented by adequately preparing both the endoscopist and the patient and by avoiding colonoscopy when specific contraindications are present. Should complications occur, their management generally follows established surgical principles. Even though colonoscopy has made a dramatic impact upon the diagnosis of and therapy for disease of the large intestines, it is important for practitioners to be mindful of its limitations. Future developments, applied rationally, can be expected to extend its usefulness and further improve its safety.

[The significance of the characteristics of lubricating jellies in use during transurethral prostate resections with metallic sheaths (author's transl)]

If a metallic sheath is used during a transurethral resection of the prostate with high-frequency currents, the lubricating jelly has to exceed a prescribed conductivity, in order to prevent dangerous current-density spots within the urethra. Furthermore, the mechanical behaviour of the lubricating jelly and the mode of its application have to be considered carefully.

Patterns of high tension electrical injury in children and adolescents and their management

High tension electrical burn injury occurred in twenty-nine patients over a period of seven years, causing two deaths, and demonstrating two reasonably distinct patterns. Major surface thermal burns from involvement in an electric arc, augmented by flame burns of ignited clothing, occurred in eleven patients. By contrast, eighteen children demonstrated wounds of entrance and exit of current and varying effects of deep thermal injury along the path of the maximally conductive blood vessels and nerves of extremities. An aggressive surgical approach was taken in patients with both types of injury, with the objective of prompt identification and excision of devitalized tissues and closure of thw wound. In the deep condictuve type of injury, frozen section and subsequent histologic study served as a guide to adequacy of excision and preservation of viable tissue. Even so, amputation of fifteen extremities and four other major excisions were required in twelve patients.

[Accidents of fulguration]

Fulguration, first electric accident in which the man was a victim, is to day better known. A clap of thunder is decomposed in two elements: lightning, and thunder. Lightning is caused by an electrical discharge, either within a cloud, or between two clouds, or, above all, between a cloud and the surface of the ground. Experimental equipments owned by the French Electricity Company and by the Atomic Energy Commission, have allowed to photograph lightnings and to measure certain physical characteristics (Intensity variable between 25 to 100 kA, voltage variable between 20 to 1 000 kV). The frequency of storms was learned: the isokeraunic level, in France, is about 20, meaning that thunder is heard twenty days during one year. Man may be stricken by thunder by direct hit, by sudden bursting, by earth current, or through various conductors. The electric charge which reached him may go to the earth directly by contact with the ground or may dissipate in the air through a bony promontory (elbow). The total number of victims, "wounded" or deceased, is not now known by statistics. Death comes by insulation breakdown of one of several anatomic cephalic formations: skull, meninx, brain. Many various lesions may happen in survivors: loss of consciousness, more or less long, sensorial or motion deficiencies. All these signs are momentary and generally reversible. Besides one may observe much more intense lesions on the skin: burns and, over all, characteristic aborescence (skin effect by high frequency current). The heart is protected, contrarily to what happens with industrial electrocution. The curative treatment is merely symptomatic : reanimation, surgery for burns or associated traumatic lesions. A prevention is researched to help the lonely man, in the country or in the mountains in the houses (lightning conductor, Faraday cage), in vehicles (aircraft, cars, ships). The mysterious and unforseeable character of lightning still stays, leaving a door opened for numerous investigations.

The cause and prevention of electrical burns of the mouth in children. A protective cuff

An epidemiological review of electrical burns of the mouth in children pinpoints the cause to the female end of extension cords. The use of a protective cuff, designed to prevent these disfiguring injuries, is suggested.

[Protective measures against increase of the potential of a "grounded" passive electrode of the electrosurgical apparatus]

Causes accounting for the occurrence of high-frequency induced burns, one of the most common types of damage inflicted on patients during electrosurgical interventions, are considered. Different variants of circuits indicating the emergence of a leakage current passing to the ground via the patient's body when this comes in contact with a grounded object are analyzed. Recommendations for the protection of patients are listed.

[Ground-isolated input circuits of the electronic diagnostic apparatus as means of increasing electric safety of the patient]

Introduction into the medical practice of new diagnostic and therapeutic methods, such as electric stimulation, measurement of intracardiac blood pressure, of pH and others, entails possible hazards for the patient to suffer an electric current injury. To ensure the patient's safety during various disturbances in the operation of the devices certain protective measures have to be devised. On an example of the electrocardiograph possible methods of accomplishing complete isolation of the patient from the ground through separating the signal and supply circuits is shown.

Burns caused by monitoring equipment during anaesthesia

Hazards of monitoring during anaesthesia are burns, cardiac arrest or ventricular fibrillation, electric shock and false alarms caused by interference with the traces. The causative and contributory factors and the measures for the prevention of burns are discussed.