Oxygen embolism caused by accidental subcutaneous injection of hydrogen peroxide during orthopedic surgery

Abstract

Introduction:We report a 39-year-old male patient with a fracture of the right acetabulum undergoing open reduction and internal fixation with a plate under general anesthesia. At closure, the surgeons injected 0.75% ropivacaine into the subcutaneous tissue of the incision wound for postoperative analgesia. Soon after injection, subcutaneous emphysema at the injection site and a sudden decrease in end-tidal CO2 tension with crude oscillatory ripples during the alveolar plateau phase were observed. Shortly thereafter, it was found that the surgeons had mistakenly injected hydrogen peroxide instead of ropivacaine. Fortunately, the patient recovered to normal status after 10 minutes. After the surgery, the patient was carefully observed for suspected pulmonary embolism and discharged without complications.Conclusion:Adverse events related to medication errors can occur in operating rooms, and most cases can be prevented through communication and verification by medical staff. The use of hydrogen peroxide should be reevaluated; when used, medical staff should be aware of the risk of oxygen embolism and take extreme care.

The role of hydrogen peroxide in hip arthroplasty: A narrative review

“…One study has even suggested that hydrogen peroxide actually contributes to aseptic loosening in the long-term; experimentally showing that the fatigue life of polymethyl methacrylate (PMMA) is reduced by a factor of 10, since hydrogen peroxide can affect the material properties of bone cement ( Guerin et al 2006 ). However, no subsequent research supporting this has been published, with various other studies in the literature proposing the opposite ( Chung and Jeong 2017 ).…”

Mild oxidative stress protects against chemotherapy-induced hair loss

“…One major drawback of this treatment is that cumene hydroperoxide and/or hydrogen peroxide would be injected subcutaneously into the scalp, and neither peroxides have yet been characterized in any therapeutic capacity. However, a report from 2017 reported a case of oxygen embolism produced by accidental introduction of subcutaneous hydrogen peroxide ( 34 ). This suggests that caution should be taken if subcutaneous hydrogen peroxide injections were to be explored further as a modality of therapy.…”

Cavography with hydrogen peroxide. Accidental injection of hydrogen peroxide into the inferior vena cava

“…If this were to occur, serious complications could arise such as cardiac arrest [1], pulmonary embolism [2,3], and stroke [4].…”