LETTERS TO THE EDITOR: Letters & Announcements
Hydrogen Peroxide Irrigation: Avoid It or Be Prepared for It?
To The Editor:
I read with interest the article by Sastre et al. (1) describing a case of left-sided gas embolism after surgical lavage of the thoracic cavity with hydrogen peroxide. It was indeed a case of direct left-sided oxygen embolism. It is known that 0.5 to 1 mL of air entering the pulmonary veins can cause coronary embolism and cardiac arrest (2). Even a few mL of hydrogen peroxide 1% was sufficient to produce enough oxygen to cause the symptoms described. The first thing observed immediately after hydrogen peroxide irrigation was an increase in ST segment in ECG lead II, III and aVF. This must have been caused by coronary oxygen embolism.
It is rather strange that even after publication of a series of case reports highlighting the hazards of hydrogen peroxide irrigation, it is being used freely to irrigate surgical fields ranging from posterior cranial fossa (3) to the pleural cavity (1). Fortunately in this patient, the transesophageal echocardiography probe was in position to detect the mishap and detect it quickly and conclusively. Perhaps it is time we prepare a protocol to be followed when hydrogen peroxide is being used intraoperatively for irrigation because early detection and prompt measures has helped in avoiding an adverse outcome in most of the cases reported so far.
Prakash K. Dubey, MD
1. Sastre JA, Prieto MA, Garzon JC. Left-sided cardiac gas embolism produced by hydrogen peroxide: intraoperative diagnosis using transesophageal echocardiography. Anesth Analg 2001; 93: 1132–4.
2. Goldfarb B, Bahnson HT. Early and late effects on the heart of small amounts of air in the coronary circulation. J Thorac Cardiovasc Surg 1980; 80: 708–17.
3. Dubey PK, Singh AK. Venous oxygen embolism due to hydrogen peroxide irrigation during posterior fossa surgery. J Neurosurg Anesthesiol 2000; 12 (1): 54–6.