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Dubey, Prakash K. MD
Department of Anesthesiology and CCM
Indira Gandhi Institute of Medical Sciences
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
© 2002 International Anesthesia Research Society
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