Abstract
Purpose
The knee-prone position is commonly used for patients undergoing spinal surgery. Venous air embolism m such a position may be produced by the negative venous pressure gradient between the ambient air and the venous plexuses of the spinous process. When hydrogen peroxide is used to deanse the wound, oxygen is produced. We report a case of suspected oxygen venous embolism during lumbar discectomy in the knee-prone position after use of H2O2.
Clinical Features
Immediately after irngation of a discectomy wound with H2O2. a dramatic decrease of the PETCO2, blood pressure and oxygen saturation coincident with ST segment elevation occurred suggesting a coronary gas embolism. Symptomatic treatment was initiated immediately 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 irngation leading to death have been reported. A review of the literature suggests 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) increases the risk of gas embolism and that hydrogen peroxide is a potentially dangerous solution.
Résumé
Objectif
La position genupectorale est fréquemment utilisée pour la chirurgie de la colonne vertébrale. Dans cette position, l’embolie gazeuse peut être causée par la création d’un gradient veineux négatif entre l’air ambiant et les plexus des apophyses épineuses. Nettoyer une plaie avec du peroxyde d’hydrogène dégage de l’oxygène. Nous rapportons un cas d’embolie veineuse causée par de l’oxygène associé à l’utilisation de H2O2 pendant une discoïdectomie lombaire en position genupectorale.
Éléments cliniques
Immédiatement après l’irngation d’une plaie de discoïdectomie avec du H2O2, une chute dramatique de la PETCO2, de la pression arténelle et de la saturation en oxygène est survenue en même temps qu’une dépression du segment ST suggérant une embolie gazeuse coronanenne. Le traitement symptomatique a été initié immédiatement et le patient a récupéré sans aucune séquelle.
Conclusion
Malgré sa réputation d’innocuité, on a rapporté des cas d’embolies massives fatales après l’mgestion accidentelle de peroxyde d’hydrogène ou après une irrigation de plaie avec ce produit. Une revue de la littérature suggère que plusieurs des caractéristiques cliniques et physiopathologiques des embolies aériennes et d’oxygène sont identiques. Dans les deux cas, les mesures préventives et curatives sont les mêmes. Nous croyons qu’il faut éviter d’utiliser le peroxyde d’hydrogène pendant des interventions où la position du patient (assise, genupectorale) augmente le nsque d’embolie gazeuse et qu’une solution de peroxyde d’hydrogène pourrait être dangereuse sous ces conditions.
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Despond, O., Fiset, P. Oxygen venous embolism after the use of hydrogen peroxide during lumbar discectomy. Can J Anaesth 44, 410–413 (1997). https://doi.org/10.1007/BF03014463
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DOI: https://doi.org/10.1007/BF03014463