Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
World Neurosurg. 2020 Nov;143:228-231. doi: 10.1016/j.wneu.2020.07.210. Epub 2020 Aug 3.
As an irrigant, an antiseptic, and a hemostatic agent, hydrogen peroxide (HO) is widely used in surgical treatment, but it has been surrounded by persistent controversy. Fatal or near-fatal embolic events caused by HO have been reported sporadically in spine surgery.
In this report, we present an 87-year-old man who underwent lumbar instrumentation removal and debridement consequent to surgical site infection in a prone position. HO was used to irrigate the infected screw tracks and surrounding tissues during the procedures. Soon after irrigation, the patient suddenly developed tachycardia, hypotension, and rapid oxygen desaturation, followed by bradycardia. Transesophageal echocardiography indicated gas embolism. After prompt first aid treatment, the patient's condition improved and the gas embolus disappeared within a few minutes without any evidence of organ embolism.
Spine surgeons should reconsider the pending results of using HO during surgery. Prolonged prone positioning and semiclosed cavities may increase the risk of gas embolism. An early diagnosis and timely intervention may be the key measures to prevent the occurrence of fatal consequences caused by gas embolism.
过氧化氢（HO）作为一种冲洗剂、防腐剂和止血剂，在外科治疗中被广泛应用，但它一直存在争议。HO 在脊柱手术中偶尔会导致致命或近乎致命的栓塞事件。
本报告介绍了 1 例 87 岁男性患者，该患者因手术部位感染，在俯卧位下行腰椎器械取出和清创术。手术过程中，HO 用于冲洗受感染的螺钉轨道和周围组织。冲洗后不久，患者突然出现心动过速、低血压和迅速的氧饱和度下降，随后出现心动过缓。经食管超声心动图提示气体栓塞。经过及时的急救治疗，患者的病情得到改善，几分钟内气体栓塞消失，没有任何器官栓塞的证据。
脊柱外科医生应重新考虑手术中使用 HO 的潜在结果。长时间俯卧位和半封闭腔可能会增加气体栓塞的风险。早期诊断和及时干预可能是预防气体栓塞引起致命后果的关键措施。
