title: Air-embolism and cerebral ischaemia following epidural hydrogen peroxide irrigation in a closed lumbar cavity.
abstract: Authors report a case of air-embolism and subsequent ischaemic damage to the brain following intra-operative irrigation with hydrogen peroxide within a closed cavity of a spinal cold abscess of tuberculous origin. Copious amount of undiluted hydrogen peroxide irrigation was deployed under moderate pressure to clean-up the abscess cavity. Post-operatively, the patient developed seizures followed by clinical and radiological features of brain ischaemia ultimately resulting in a fatal outcome. The authors reflect on the events, review the relevant literature regarding intra-operative use of hydrogen peroxide in cranio-spinal procedures, outline mechanism of its actions, and highlight its disadvantages and potential complications.
authors.affiliation: Department of Neurosurgery, Sevenhills Hospital , Andheri (East), Mumbai , India.
authors.forename: Prasanna S
authors.initials: PS
authors.lastname: Patankar
authors.forename: Shashank S
authors.initials: SS
authors.lastname: Joshi
authors.forename: Kishor A
authors.initials: KA
authors.lastname: Choudhari
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000139:chemically induced / Q000601:surgery*; D002544:Cerebral Infarction / Q000175:diagnosis / Q000601:surgery*; D004618:Embolism, Air / Q000139:chemically induced / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D006861:Hydrogen Peroxide / Q000009:adverse effects*; D007431:Intraoperative Complications / Q000601:surgery; D008161:Lumbosacral Region / Q000473:pathology / Q000601:surgery*; D008297:Male; D007507:Therapeutic Irrigation
chemical_list: D006861:Hydrogen Peroxide
keywords: cold abscess; hydrogen peroxide; intra-operative irrigation; ischaemic brain damage; vasospasm