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.

Keywords::

• cold abscess
• hydrogen peroxide
• intra-operative irrigation
• ischaemic brain damage
• vasospasm

Declaration of interest: The authors report no declarations of interests. The authors alone are responsible for the content and writing of the paper. The authors confirm that patient consent has been obtained in the illustrative case.