1例过氧化氢冲洗骨髓脓腔致肺氧气栓塞的抢救及启示

对1例右侧胸腔积液、脑梗死伴右股骨骨髓腔脓肿患者行3%过氧化氢右股骨骨髓脓腔冲洗致肺氧气栓塞患者,立即实施面罩加压给氧,胸外心脏按压并气管插管、镇静等急救措施,成功后转ICU行抗感染、脱水、降颅内压等治疗。次日拔除气管导管后患者病情稳定、生命体征稳定转入骨科病房。护理启示:对于高危患者选用低浓度过氧化氢或生理盐水冲洗。一旦发生肺氧气栓塞,迅速调整患者体位至左侧位或头低30°位,将栓子局限在右心房或心房与腔静脉结合处,密切配合医生抢救,可使患者转危为安。     

Oxygen embolism after intraoperative use of hydrogen peroxide

Hydrogen peroxide is widely used for irrigation of surgical wounds. However, its administration has been associated with gas embolism. We report a case of gas embolism after wound irrigation with hydrogen peroxide in a 11-year-old boy undergoing extraction of the extra-traumatic splint under general anesthesia. When 3% hydrogen peroxide 12 ml was applied to wound of the left femur after extraction of the splint, the patient showed clinical signs of pulmonary embolism. Symptomatic treatment was initiated immediately. When the patient awoke from anesthesia, he showed tonic convulsion. But he recovered without any complications. The administration of hydrogen peroxide into a closed tissue is contraindicated during surgery.     

Oxygen embolism due to hydrogen peroxide irrigation during cervical spinal surgery

Hydrogen peroxide is used to cleanse and irrigate wounds. As it decomposes immediately into water and oxygen on contact with organic tissue, it is usually regarded as a safe agent. We report a case of oxygen embolism associated with hydrogen peroxide irrigation of the surgical field during anterior fusion of the cervical vertebrae. It was accompanied by precipitous hypotension and decrease in pulse oximetry oxygen saturation and end-tidal CO₂ tension. Semi-closed spaces formed under the apatite dowel and between the apatite dowel and vertebral bodies may have precipitated the absorption of oxygen bubbles into the vasculature. Although this case was associated with a rapid recovery and uneventful sequelae, it discourages the use of hydrogen peroxide in this procedure because of the potential hazards including cardiovascular collapse. On utilise le peroxyde d’hydrogène pour nettoyer et irriguer les plaies. Comme il se décompose instantanément en eau et en oxygène au contact d’un tissus organique, on le considère inoffensif. Nous rapportons un cas d’embolie associée à l’irrigation d’une plaie au peroxyde d’hydrogène pendant une fusion cervicale antérieure. L’embolie s’est manifestée par une hypotension subite et une chute de la saturation en oxygène et du CO₂ téléexpiratoire. La présence d’espaces semi-clos sous le pivot d’apatite et entre le pivot d’apatite et le corps vertébral peut avoir précipité l’absorption des bulles d’oxygène dans l’arbre vasculaire. Bien que ce malade ait récupéré rapidement et sans séquelles, il est préférable de ne pas utiliser le peroxyde d’hydrogène pendant cette intervention à cause du danger inhérent de collapsus vasculaire.     

Gas embolism produced by hydrogen peroxide abscess irrigation in an infant.

The production of gaseous oxygen when hydrogen peroxide interacts with tissue is a well-known phenomenon that has been reported as a rare cause of gas embolism. We present the case of an 11-month-old infant who sustained an immediate cardiorespiratory arrest following the use of this agent during a minor surgical procedure. Clinical features, radiological findings and the rapid response to resuscitation were strongly suggestive of major gas embolism. Adverse effects of inappropriate use of hydrogen peroxide, and the diagnosis and management of these problems are discussed.     

Oxygen venous embolism after the use of hydrogen peroxide during lumbar discectomy

Purpose

The knee-prone position is commonly used for patients undergoing spinal surgery. Venous air embolism m such a position may be produced by the negative venous pressure gradient between the ambient air and the venous plexuses of the spinous process. When hydrogen peroxide is used to deanse the wound, oxygen is produced. We report a case of suspected oxygen venous embolism during lumbar discectomy in the knee-prone position after use of H₂O₂.

Clinical Features

Immediately after irngation of a discectomy wound with H₂O₂. a dramatic decrease of the P_ETCO₂, blood pressure and oxygen saturation coincident with ST segment elevation occurred suggesting a coronary gas embolism. Symptomatic treatment was initiated immediately and the patient recovered without any sequelae.

Conclusion

Although hydrogen peroxide has an innocuous reputation, cases of accidental ingestion or massive gas embolism after wound irngation leading to death have been reported. A review of the literature suggests that many of the clinical and physiopathological features of air and oxygen emboli are similar. For both, measures of prevention and treatment of complications are similar. We argue that the use of hydrogen peroxide should be avoided during procedures where the position of the patient (sitting, knee-prone) increases the risk of gas embolism and that hydrogen peroxide is a potentially dangerous solution.     

The absence of arterial oxygen desaturation during massive oxygen embolism after hydrogen peroxide irrigation

For decades, water-mill murmur, decrease in end-tidal CO(2) (Petco(2)), hypotension, and hypoxemia have been accepted as diagnostic criteria for gas embolism. In this case report, a 19-yr-old male patient developed a sudden reduction in Petco(2) and profound circulatory collapse 15 min after intramedullary irrigation with H(2)O(2). However, arterial oxygen desaturation never developed throughout the entire course of resuscitation from presumed massive oxygen embolism.     

Venous oxygen embolism due to hydrogen peroxide irrigation during posterior fossa surgery

Hazards of application of hydrogen peroxide to semiclosed space are well known. We present a case of suspected gas embolism following hydrogen peroxide irrigation of the surgical field during posterior fossa surgery in the prone position. Severe cardiovascular collapse occurred when the wound was irrigated with hydrogen peroxide solution. Generation of pressure gradient leads to absorption of a considerable amount of oxygen giving rise to features of venous gas embolism. Although the case was associated with an uneventful recovery, use of hydrogen peroxide for securing hemostasis should be avoided.     

Iatrogenic gas embolism after the use of hydrogen peroxide

We report a case of severe oxygen embolism after wound irrigation under pressure with hydrogen peroxide into a closed or partially closed cavity. The accident was observed during a surgical dressing of a large pelvis gangrene area, after a 250 ml injection of hydrogen peroxide. Suddenly occurred a decrease in PETCO(2) and SpO(2), and then heart arrhythmia. Symptomatic treatment initiated immediately restored SpO(2) and heart rhythm within a few minutes and the patient was then treated with hyperbaric oxygen therapy. The patient recovered without cardiac or neurologic sequelae. The release of gaseous oxygen under the effect of tissue catalase and the vascular diffusion of this oxygen bubbles can explain such complication. Injection of large volume of hydrogen peroxide into a closed or partially closed cavity and/or under pressure injection must be prohibited.     

Bladder irrigation using hydrogen peroxide for clot evacuation

Evacuation of clot from the bladder by irrigation can be difficult when significant clot burden or organized clot exists. We describe a novel technique for the evacuation of clot from the bladder using irrigation containing hydrogen peroxide that facilitated clot removal.     

经尿道前列腺电切术后低浓度过氧化氢溶液膀胱冲洗的疗效分析

目的:评价低浓度过氧化氢溶液在经尿道前列腺电切术(TURP)后持续膀胱冲洗中有效性和安全性。方法:回顾性分析2013年1月至2017年1月期间共148例良性前列腺增生(BPH)行TURP手术治疗的患者临床资料。根据患者术后持续膀胱冲洗液的不同分为A、B两组,A组76例接受0.15%过氧化氢溶液行膀胱冲洗;B组72例接受生理盐水行膀胱冲洗。记录两组患者术后血红蛋白浓度值下降情况,膀胱持续冲洗时间,导尿管堵塞次数、留置导尿管时间,术后住院天数。结果:术前两组患者前列腺体积、国际前列腺症状评分(IPSS)、最大尿流率(Qmax)、残余尿(PVR)、PSA及血红蛋白值相比差异无统计学意义(P0.05)。术后48 h内平均血红蛋白(Hb)下降水平:A组Hb下降了(3.38±2.56)g/L,B组Hb下降了(7.29±6.58)g/L;持续膀胱冲洗时间:A组为(32.57±5.99)h,B组为(46.10±8.79)h;两组相比差异均有统计学意义(P0.01)。A组患者术后尿管堵塞率为3.3%、留置尿管时间为(3.74±0.79)d、住院天数为(4.22±0.81)d;B组术后尿管堵塞率为11.8%、留置尿管时间为(4.79±0.93)d、住院天数为(4.67±0.88)d;两组相比差异均有统计学意义(P0.01)。结论:前列腺电切术后应用低浓度过氧化氢溶液行膀胱持续冲洗可以减少出血,降低导尿管堵塞发生率,缩短膀胱冲洗时间、术后导尿管留置时间和住院天数,值得在临床中进行推广。     

Iatrogenic gas embolism following surgical lavage of a wound with hydrogen peroxide

The use of hydrogen peroxide (H2O2) in surgery for its antiseptic properties has been associated with life-threatening complications. We report a case of severe oxygen embolism after wound irrigation with H2O2 in a 17-year-old boy undergoing surgical dressing of a large thigh trauma under general anaesthesia. During muscle lavage with 400 mL of H2O2 3%, severe shock suddenly occurred. On the basis of clinical presentation, the diagnosis of pulmonary gas embolism was strongly suspected. Symptomatic treatment initiated immediately, restaured a normal haemodynamic state within a few minutes and the patient recovered without sequelae. The degradation of H2O2 results in considerable amounts of gaseous oxygen. One mL of H2O2 can produce in the tissues 10 mL of oxygen. This gas can enter the circulation and determine severe embolism. The treatment should be initiated without delay. The administration of H2O2 under pressure is contraindicated during surgery.     

Standardized irrigation technique reduces intraabdominal abscess after appendectomy

Purpose

The utility of irrigation at the time of appendectomy for acute appendicitis has been debated, with recent studies showing no benefit to irrigation. In our practice, two techniques have been used; one in which irrigation was at the discretion of the surgeon, and one in which irrigation was standardized. The standardized irrigation technique involved large volume (3–12?l) irrigation in small, focused, directed aliquots to achieve optimal dilution. We sought to retrospectively assess whether the standardized large volume irrigation technique was associated with measurably reduced intraabdominal infection. We hypothesized that there would be no difference in intraabdominal infection rate.