Massive Cerebral Gas Embolism under Discectomy due to Hydrogen Peroxide Irrigation

Abstract

Massive cerebral and spinal gas embolism occurs rarely as a complication of discectomy. We report a 54-year-old female who had undergone a discectomy (L3/4 and L4/5) under epidural anesthesia in a local hospital developed multiple massive gas embolisms. At closure, surgeons irrigated the incision wound with hydrogen peroxide. Soon after the irrigation, the patient suddenly developed tachycardia, hypotension, and rapid oxygen desaturation. Subsequently, patient progressed into unconsciousness and right hemianopsia quadriplegia. Computed tomography (CT) scan showed multiple hypointensity spots around the brain due to cerebral gas embolism, which indicated the pneumoencephalos. The likely mechanism was the absorption of hydrogen peroxide into blood. When the amount of oxygen evolved exceeded its maximal blood solubility, venous embolization occurred. Though the patient was treated with supportive treatments and hyperbaric oxygen, she did not get full recovery and was left with severe long-term cerebral injury.

An Ingestion of Industrial Strength Hydrogen Peroxide Resulting in Cerebral Embolism and Death

“…Watt BE et al reported that ingestion of 30 mL of hydrogen peroxide would result in 3.5 L of oxygen production. [2] When oxygen concentration exceeds its maximum solubility in blood, it leads to gas embolism especially in the portal venous system, gastric wall, and brain as was demonstrated in our patient [8,9].…”

A Case of Paradoxical Embolism Causing Anterior Spinal Cord Syndrome and Acute Myocardial Infarction Following the Intradiscal Oxygen-Ozone Therapy

“…As a result, the accident is most probably caused by air embolus produced by oxygen–ozone injection and subsequently entering arterial circulation. It has been demonstrated that neurologic deficits and cardiac arrest are common clinical symptoms of arterial air embolism (17–19). The initial clinical manifestation of this patient was the relatively rare anterior spinal cord syndrome caused by paradoxical embolism of anterior spinal artery (20).…”

Антибактериальная Терапия Гнойных Ран

“…Задача антисептиков -устра-нение или сокращение числа микроорганизмов в ране и исключение отрицательного воздействия на пролиферацию и регенерацию тканей. Эту задачу выполняют не все традиционно применяемые лекарственные средства, некоторые из них отрицательно влияют на поздние фазы раневого процесса [15,17,19].…”