Oxygen embolism after hydrogen peroxide irrigation of a vulvar abscess

Abstract

We report a case of venous oxygen embolism in a 33-yr-old healthy woman after irrigation of a vulvar abscess with 25 ml of 3% hydrogen peroxide. Venous oxygen embolism was diagnosed by the development of sudden hypoxia associated with a decrease in end-tidal carbon dioxide concentration from 5.3 kPa to 3.2 kPa, and a 'mill-wheel' sound on cardiac auscultation soon after injection of the solution. The patient responded to corrective treatment including the Trendelenburg position and 100% oxygen. She made an uneventful recovery. We discuss the possible causative mechanism of this embolism, the different diagnostic methods, and the controversial aspects of available treatments. We emphasize that hydrogen peroxide is a dangerous and unsuitable agent for routine wound irrigation and debridement.

Embolie gazeuse après utilisation d'eau oxygénée pour le traitement d'un abcès mammaire

“…Des cas d'embolie gazeuse après utilisation d'eau oxygé-née ont été décrits dans de nombreuses circonstances, y compris dans le cas d'abcès vulvaire [5]. À notre connaissance, c'est le premier cas rapporté après traitement d'un abcès mammaire.…”

Venous Air Embolism

“…Echocardiography may become more important in the diagnosis of VAE outside the operating room as expertise and equipment availability increase in the critical care environment. Pressure infusion devices [53][54][55] Shoulder arthroscopy 16,17 Mechanical ventilation 3,4,37 Surgery on the spine 18,19 Cavitron ultrasonic surgical aspirator® for hepatic resection 38,39 Total hip arthroplasty 20 Argon beam coagulator [40][41][42] Cesarean delivery 21 YAG laser 34 Prostate surgery 22,23 Endoscopic vein harvesting [43][44][45] Liver surgery 24 -26 Endoscopy 46 -48 Eye surgery 27 Use of hydrogen peroxide [49][50][51][52] 58 These pressures can easily exceed venous pressure depending on the patient's volume status and position. Because insufflation during gastrointestinal endoscopy is intermittent and low pressure, the risk of VAE is low.…”

“…52 When used as a surgical irrigant or as an aid to localize fistulous tracts, oxygen embolism can occur. [49][50][51][52] It is more likely that hydrogen peroxide is directly absorbed in vascularized closed spaces, resulting in intravascular catabolism and evaporation of oxygen. 50 The composition of the offending gas can affect the severity of VGE.…”

Delayed diagnosis of an epidural haematoma with a working epidural in situ

“…The staff responsible for setting up these trolleys had confirmed these products to be latex-free by telephoning the manufacturer. We checked the Portex website [1], which gives a list of products containing latex. To our surprise, the same web page states 'While every effort is made to keep this list up-to-date and accurate, Portex Limited reserves the right to change the specification of its products at any time.…”

“…If the motor deficit does not resolve within 2 h, an urgent MRI is the diagnostic procedure of choice [1]. Rapid surgical decompression [2] performed within 12 h if possible [3,4] is associated with a more favourable outcome.…”