Which procedure presents the highest risk of fire during the intra-operative phase?

The procedure that presents the highest risk of fire during the intra-operative phase is tracheostomy. This risk is heightened because tracheostomy procedures often involve the use of oxygen and can involve electrosurgical devices, which generate sparks. In a sterile environment where flammable materials such as drapes, gauze, and even skin prep solutions are present, the combination of increased oxygen concentration and electrosurgical instruments creates a significant potential for ignition and fire.

During tracheostomy, the airway is manipulated and secured, often requiring the use of supplemental oxygen; if an electrosurgical device is inadvertently activated, the risk of a fire is greatly amplified in the presence of the flammable substances. Other procedures listed, while they may have their own risks and require careful handling of instruments and materials, typically do not present the same level of fire risk associated with the combination of high oxygen levels and active electrosurgical equipment.