Gas Embolism

Started by yogenbhatt1, June 13, 2007, 04:51:21 PM

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Gas Embolism.
I know that this word can dilate our sphincters.
I had a case of Fistula in ano under GA with LMA.
Standard induction with Fentanyl, Medazolam, Glycopyrolate, Pre oxygenation, Propofol, Vecuronium, and intubation with LMA. All parameters normal till at about 20 mins after starting surgery things started happening.
I have  group of 4 qualified anaesthesiologists. One of them was on the pulse. Multi paramonitor was connected. Second anaesthesiologist was writing notes and drug list etc. I was just around in the OT.
First assistant started making movements. ON inquiring she said " No Radial"
Monitor took next NIBP reading:50/20mmBP.
SpO2 started dropping. N2O stopped. Quickly LMA removed and endotracheal tube put. 100% O2 with venti given.
No change. SpO2 now 70%. BP not recordable. Vaso Pressures given.
No improvement.
I went to surgeons trolly. Asked the sister about what is in the bowls. She said one is Savlon, Betadine, and Hydrogen Paroxide.
I asked the assistant to auscultate. She said air entry was equal on intubation. I asked for murmur, she said there was no murmur preop.
I asked her to re auscultate. She said there is some funny loud murmur. In a fluke I said this is called a Mill Wheel Murmur. I had never heard it before.
The surgeon had injected 10ml of Hydrogen Paroxide to find the internal opening of the Fistula in ano.
The murmur vanished in about a min and SpO2 was about 52%.
It was not possible to give  Durrant's position from lithotomy possision.  nor was it possible to put in a central line.
We were just waiting for the fate. Suddenly the SpO2 started rising. BP came up till 120 systolic. And Patient was fully conscious at reversal.
Was discharged on third day and he had no clue about the diagnosis.
Any one can throw some light on this case.
any easier way to manage this crisis.
Any one with a simillar experience?


I think u work in luxurious surrounding with four qualified anesthesiologist and well managed air embolism.

I have come across one such situation during intra cerebral aneurysm clipping.


I presented this case in a local state chapter 3 day conference as a paper reading. Incidentally atleast 3 anaesthesioloists got up to say, that now retrospectivly they think that they had lost one case each, but under spinal anaesthesia.They thought it was spinal hypotension that killed the pt but, now they think that the pt died of gas embolism. Hydrogen Peroxide was used in their cases.


The likely reason is the foaming of H2O2. It  foams  because blood and cells contain an enzyme called catalase. Since a cut or scrape contains both blood and damaged cells, there is lots of catalase floating around.
When the catalase comes in contact with hydrogen peroxide, it turns the hydrogen peroxide (H2O2) into water (H2O) and oxygen gas (O2).
2H2O2 --> 2H2O + O2
Catalase does this extremely efficiently -- up to 200,000 reactions per second. The bubbles you see in the foam are pure oxygen bubbles being created by the catalase. Try putting a little hydrogen peroxide on a cut potato and it will do the same thing for the same reason -- catalase in the damaged potato cells reacts with the hydrogen peroxide.

This reaction also liberates a lot of heat. The forcing-in of O2 bubbles into open cappilaries follows a similar technique as methy-methacrylate (bone cement) embolism. This also happens due to an exothermic reaction.

The usual concentration is 3%. If u use 90-% concentration , hydrogen peroxide makes a great rocket propellant!


Shivdatta, you would make a great scientist.
This knowledge is great to acquire. It has a lot of scientific details.