[Fatal gas embolism during corrective surgery for scoliosis using the posterior approach]

Use of hydrogen peroxide as a germicide and hemostatic agent during surgery has been associated with gas embolism that can prove fatal. A 15-year-old girl with severe kyphoscoliosis undergoing vertebral arthrodesis by a posterior route experienced worsening of respiratory function and hemodynamic variables coinciding with the massive irrigation of the surgical area with hydrogen peroxide. Noteworthy among the relevant signs was a sharp fall in CO2 end expiratory pressure (PetCO2) and oxygen saturation (SpO2) by pulse oximetry as well as hypotension and bradycardia. The patient died in spite of treatment. Availability of appropriate monitoring allows this type of complication to be suspected early. Other than life support measures, treatment should include elimination of the cause as soon as possible by rinsing the surgical field or the point of gas entry with saline solution, as well as evacuation of the gas through a venous catheter. Although gas embolisms happen much more often than we are able to detect them, most have no important effects. As serious complications may develop under certain circumstances, however, the use of less dangerous irrigation products is advisable.