• Sheng-Li Zhao, Xiao-Yan Zhang, Ying Xiao, Xiao-Yi Mo, Zhi-Peng Chen, Wei Lin, Zi-Fang Huang, and Bai-Ling Chen.
• Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
• World Neurosurg. 2020 Nov 1; 143: 228-231.

BackgroundAs an irrigant, an antiseptic, and a hemostatic agent, hydrogen peroxide (H2O2) is widely used in surgical treatment, but it has been surrounded by persistent controversy. Fatal or near-fatal embolic events caused by H2O2 have been reported sporadically in spine surgery.Case DescriptionIn this report, we present an 87-year-old man who underwent lumbar instrumentation removal and debridement consequent to surgical site infection in a prone position. H2O2 was used to irrigate the infected screw tracks and surrounding tissues during the procedures. Soon after irrigation, the patient suddenly developed tachycardia, hypotension, and rapid oxygen desaturation, followed by bradycardia. Transesophageal echocardiography indicated gas embolism. After prompt first aid treatment, the patient's condition improved and the gas embolus disappeared within a few minutes without any evidence of organ embolism.ConclusionsSpine surgeons should reconsider the pending results of using H2O2 during surgery. Prolonged prone positioning and semiclosed cavities may increase the risk of gas embolism. An early diagnosis and timely intervention may be the key measures to prevent the occurrence of fatal consequences caused by gas embolism.Copyright © 2020 Elsevier Inc. All rights reserved.

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