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CARDIOVASCULAR ANESTHESIA

The Absence of Arterial Oxygen Desaturation During Massive Oxygen Embolism After Hydrogen Peroxide Irrigation

Wei-Zen Sun, MD^*, Chin-Shuang Lin, MD^*, Andy A. Lee, MD, and Wei-Hung Chan, MD^*

*Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; and Department of Anesthesiology, University of Washington, Seattle, Washington

Address correspondence and reprint requests to Wei-Zen Sun, MD, Department of Anesthesiology, National Taiwan University Hospital, No. 7, Chung-Shan South Rd., Taipei 10016, Taiwan. Address e-mail to wzsun{at}ntu.edu.tw

For decades, water-mill murmur, decrease in end-tidal CO₂ (PETCO₂), hypotension, and hypoxemia have been accepted as diagnostic criteria for gas embolism. In this case report, a 19-yr-old male patient developed a sudden reduction in PETCO₂ and profound circulatory collapse 15 min after intramedullary irrigation with H₂O₂. However, arterial oxygen desaturation never developed throughout the entire course of resuscitation from presumed massive oxygen embolism.

IMPLICATIONS: We describe a young patient who developed circulatory collapse after intramedullary irrigation with H₂O₂. Notably, arterial oxygen saturation did not substantially change throughout the resuscitation from presumed oxygen embolization.