Intraoperative oxygen embolus and tension pneumocephalus: Is hydrogen peroxide the culprit?

Dsouza, Supriya; Parakh, Anil; Sarma, Chitra; Kulkarni, Adarsh; Baviskar, Ajit

doi:10.4103/jnacc-jnacc-11.17

Cited by 1 publication

(1 citation statement)

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“…The surgeon should be aware that for every 1 cc of H 2 O 2 , 10 cc of O2 are produced [9].The rapidly freed oxygen may directly irritate the nuclei of cardiovascular function of the brainstem or have an indirect effect due to the thermal energy of the dissociation [9]. Additionally, the trigemino-cardiac reflex, which is a well-described clinical reaction, is also attributed to the liberation of abundant O2 from H 2 O 2 , capable of exerting a considerable simultaneous chemical irrigation on the dura covering of the brain surface and being innervated by V2 and V3 (trigeminal nerve division 2 nd , 3 rd ) nerve roots [10].…”

Section: Discussionmentioning

confidence: 99%

Postoperative Tetraplegia to a Child after Cerebellar Pilocytic Astrocytoma Excision at Prone Position: Case Report and Literature Review

et al. 2020

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Unusual clinical course Background: Various factors have been implicated in the pathogenesis of infarction after posterior fossa surgery such as venous air embolism, patient's position (seated or prone), hyperflexion of the neck, excessive spinal cord traction, cervical canal stenosis, and systemic arterial hypotension. The main aim of this case report was to elucidate a case in which hydrogen peroxide was implicated in a major and systemic complication after a neurosurgical procedure. Case Report: We describe the case of a 5-year-old female patient who was admitted to our hospital because of a cerebellar hemispheric astrocytoma associated with obstructive hydrocephalus and accompanied by 2 syringomyelic cavities in the cervicothoracic portion of the spinal cord. Immediately after gross total resection of the lesion, impaired mobility of the upper and lower extremities was observed, a finding that was not consistent with intraoperative neurophysiologic monitoring data. Hydrogen peroxide had been judiciously used to irrigate the resection tumor cavity. In the next few postoperative days, the patient suffered from transient diabetes insipidus and hyperpyrexia, indicative of hypothalamic injury. Conclusions: Neurological evaluation of the patient, after stabilization of her medical condition, revealed residual spasticity of upper and lower extremities, rendering her able to mobilize via the aid of wheelchair only. The most possible pathophysiologic explanation of her neurological deterioration, including hypothalamic dysfunction, was analyzed. The role of hydrogen peroxide as a source of free radical formation, and its co-responsibility for vascular platelet aggregation and vasoconstriction was considered, upon case review, the main responsible etiologic factor.

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Section: Discussionmentioning

confidence: 99%