Air Embolism Associated with Irrigation of External Fixator Pin Sites with Hydrogen Peroxide
A Report of Two Cases
Noel Henley, MD; DuWayne A. Carlson, MD; David M. Kaehr, MD; Brittany Clements

Hydrogen peroxide is a relatively common irrigant used for cleansing infected and dirty wounds1. Although air embolism has been noted in association with the use of hydrogen peroxide during orthopaedic procedures, the reported cases of this complication appeared in the anesthesia literature2,3. We report the cases of two patients in whom a catastrophic event occurred in association with the use of hydrogen peroxide for irrigation of external fixator pin sites. Both incidents occurred near the same time at different institutions. We present these cases in order to help others to avoid similar complications.

Case Reports

Case 1. A forty-eight-year-old woman was taken to the operating room for removal of a pelvic external fixator, removal of Kirschner wires from the wrist, and manipulation of the knee. She had been involved in a motor-vehicle accident eight weeks earlier, at which time she had sustained multiple fractures, including a pelvic fracture that was stabilized with an external fixator. The medical history was remarkable only for depression.

General anesthesia was induced without incident. The external fixator and the Kirschner wires were removed, and the knee was manipulated. The external fixator pin sites in the pelvis were débrided, and the osseous tunnels were irrigated with at least 100 mL of half-strength hydrogen peroxide solution with use of a syringe and an angiocatheter. Several minutes later, the anesthesiologist reported a precipitous drop in the patient's blood pressure and oxygen saturation. Pulseless electrical activity was noted, and chest compressions and Advanced Cardiac Life Support protocols were instituted. After ten minutes of resuscitation, a pulse and blood pressure were again noted. …


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