Oxygen venous embolism after the use of hydrogen peroxide during lumbar discectomy

Abstract

Purpose: The knee-prone position is commonly used for patients undergoing spinal surgery. Venous air embolism in such a position may be produced by the negative venous pressure gradient between the ambiant air and the venous plexuses of the spinous process. When hydrogen peroxide is used to cleanse the wound, oxygen is produced. We report a case of suspected oxygen venous embolism during lumbar discectomy in the knee-prone position after use H2O2. Clinical Features: Immediatly after irrigation of a discectomy wound with H2O2, a dramatic decrease of the P(ET)CO2, blood pressure and oxygen saturation coincident with ST segment elevation occurred suggesting a coronary gas embolism. Symptomatic treatment was initiated immediatly and the patient recovered without any sequelae. Conclusion: Although hydrogen peroxide has an innocuous reputation, cases of accidental ingestion or massive gas embolism after wound irrigation leading to death have been reported. A review of the literature suggest that many of the clinical and physiopathological features of air and oxygen emboli are similar. For both, measures of prevention and treatment of complications are similar. We argue that the use of hydrogen peroxide should be avoided during procedures where the position of the patient (sitting, knee-prone) increase the risk of gas embolism and that hydrogen peroxide is a potentially dangerous solution.