Hydrogen peroxide
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Gas embolism in the right atrium: case report An 87-year-old man developed gas embolism in the right atrium during treatment with hydrogen peroxide used as an irrigant during the surgery. The man was admitted for lumbar instrumentation removal and debridement under general anaesthesia. One year previously, he had undergone posterior lumbar interbody fusion surgery (L4/L5) for lumbar spinal stenosis. Postoperatively, he had developed incision infection with sinus formation. He also had a history of hypertension and diabetes, which were under control with unspecified medications. On current admission, he was placed in a prone position. Following routine induction, a tracheal intubation and mechanical ventilation were given. Anaesthesia was maintained with sevoflurane. After lesion curettage in the screw tracks and surrounding tissues, a 20mL of 3% hydrogen peroxide was used to wash the surgical site thoroughly [route not stated]. Subsequently, he developed a sudden increase in heart rate (tachycardia), followed by a rapid decrease (bradycardia). He also had hypotension, along with decreased oxygen saturation, cyanosed skin and a sharp decrease in end-tidal carbon dioxide level. Based on these findings, a highly doubtful diagnosis of gas embolism was made. The surgery was stopped, and the man was immediately changed to the supine position. Then, he was administered ephedrine, epinephrine and atropine. He required chest compressions when the heart rate fell below 35 bpm. An emergent intraoperative transoesophageal echocardiography (TEE) suggested a gas embolus in the right atrium. Over the next 10 minutes, his vital signs stabilised. A repeat TEE revealed that the gas embolus had disappeared. Zhao S-L, et al. Gas Embolism After Hydrogen Peroxide Use During Spine Surgery: Case Report and Literature Review. World Neurosurgery 143: 228-231, Nov 2020. Available from: URL: http://doi.org/10.1016/j.wneu.2020.07.210 803503541
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Reactions 26 Sep 2020 No. 1823
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