Oxygen Embolism and Pneumocephalus After Hydrogen Peroxide Application During Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery: A Case Report and Literature Review.

Peng Zou, Jun-Song Yang, Xiang-Fu Wang, Jian-Min Wei, Hao Guo, Bo Zhang, Fan Zhang, Lei Chu, Ding-Jun Hao, Yuan-Tin Zhao

Journal: World neurosurgery 2020;138():201-204

PMID: 32179190

Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND

Hydrogen peroxide (HO) solution is commonly used to irrigate wounds because of its hemostatic and antiseptic properties. Previous studies suggest that HO can result in toxicity to keratinocytes and fibroblasts, but complications after HO application, including oxygen embolism, which is one of the most severe, have rarely been reported.

CASE DESCRIPTION

A 40-year-old woman was diagnosed with L4-5 lumbar spinal stenosis and subsequently underwent minimally invasive transforaminal lumbar interbody fusion treatment at another hospital. Hypotension, hypoxia, and a decrease in end-tidal carbon dioxide pressure occurred immediately after HO irrigation. After the operation, she was able to be extubated but remained comatose. Postoperative computed tomography scan revealed intracranial air trapping in the right frontal lobe and multiple cerebral infarction foci.

CONCLUSIONS

When using a knee-prone surgical position or in cases of dural laceration, the application of undiluted HO solution should be avoided, especially in a surgical wound within a closed cavity. When hypotension, hypoxia, and a decrease in end-tidal carbon dioxide pressure occur immediately after HO irrigation, oxygen embolism should be strongly suspected.

Address: Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.; Department of Spinal Minimally Invasive Surgery, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, Gansu, China.; Department of Spine Surgery, Baoji City Hospital of Traditional Chinese Medicine, Shaanxi, China.; No. 3201 Affiliated Hospital of Medical College of Xi'an Jiaotong University, Hanzhong, Shaanxi, China.; Department of Orthopaedics, Tongchuan People's Hospital, Tongchuan, China.; Department of Orthopaedics, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China.; Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China. Electronic address: [email protected].

DOI: 10.1016/j.wneu.2020.03.035

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MeSH Terms: Adult, Anti-Infective Agents, Local, Embolism, Air, Female, Humans, Hydrogen Peroxide, Lumbar Vertebrae, Minimally Invasive Surgical Procedures, Oxygen, Pneumocephalus, Postoperative Complications, Spinal Fusion, Spinal Stenosis