Despond O, Fiset P
Department of Anaesthesia, Royal Victoria Hospital, McGill University, Montréal, QC, Canada.
Can J Anaesth. 1997 Apr;44(4):410-3. doi: 10.1007/BF03014463.
The knee-prone position is commonly used for patients undergoing spinal surgery. Venous air embolism in 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 cleanse 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.
Immediately after irrigation of a discectomy wound with H2O2, a dramatic decrease of the PETCO2, 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.
Although hydrogen peroxide has an innocuous reputation, cases of accidental ingestion or massive gas embolism after wound irrigation 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.
俯卧位常用于脊柱手术患者。在此体位下，静脉空气栓塞可能由周围空气与棘突静脉丛之间的负静脉压力梯度产生。当使用过氧化氢清洁伤口时会产生氧气。我们报告一例在使用过氧化氢后俯卧位行腰椎间盘切除术期间疑似氧静脉栓塞的病例。
在用过氧化氢冲洗椎间盘切除伤口后，呼气末二氧化碳分压、血压和血氧饱和度急剧下降，同时伴有ST段抬高，提示冠状动脉气体栓塞。立即开始对症治疗，患者康复且无任何后遗症。
尽管过氧化氢素有无害之名，但已有伤口冲洗后意外摄入或大量气体栓塞导致死亡的病例报道。文献综述表明，空气栓塞和氧栓塞的许多临床和生理病理特征相似。对于两者，并发症的预防和治疗措施也相似。我们认为，在患者体位（坐位、俯卧位）增加气体栓塞风险的手术过程中应避免使用过氧化氢，并且过氧化氢是一种潜在危险的溶液。
