OxyFile #250

Oxygen embolism due to hydrogen peroxide irrigation during 
cervical spinal surgery.


Author: Morikawa H; Mima H; Fujita H; Mishima S


Source: Can J Anaesth 1995 Mar; 42(3):231-3

Abstract:

Hydrogen peroxide is used to cleanse and irrigate wounds. 
As it decomposes immediately into water and oxygen on contact 
with organic tissue, it is usually regarded as a safe agent. 
We report a case of oxygen embolism associated with hydrogen 
peroxide irrigation of the surgical field during anterior 
fusion of the cervical vertebrae. It was accompanied by 
precipitous hypotension and decrease in pulse oximetry 
oxygen saturation and end-tidal CO2 tension. Semi-closed 
spaces formed under the apatite dowel and between the apatite 
dowel and vertebral bodies may have precipitated the absorption 
of oxygen bubbles into the vasculature. Although this case 
was associated with a rapid recovery and uneventful sequelae, 
it discourages the use of hydrogen peroxide in this procedure 
because of the potential hazards including cardiovascular 
collapse.