Use of hydrogen peroxide in neurosurgery: case series of cardiovascular complications

OBJECTIVES Postoperative complications induced by hydrogen peroxide (H(2)O(2)) are described in the neurosurgical literature and mainly involve oxygen venous emboli, postoperative pneumocephalus; some of them even fatal. However, recently there are more and more published case reports for significant cardiac dysrhythmia related to the use of this chemical agent during routine neurosurgical interventions. DESIGN Retrospective, two-centre study. SETTING Retrospective review of clinical/radiological documentation (including preoperative medical history, operation report and intraoperative anesthesiology data charts). PARTICIPANTS Patients scheduled for cranial neurosurgical interventions. MAIN OUTCOME MEASURES Intraoperative occurrence of trigeminocardiac reflex (TCR), according the earlier defined by our group criteria, or other severe cardiovascular complications related to the intraoperative use of H(2)O(2). RESULTS Five cases were included in the study fulfilling the strict inclusion/exclusion criteria. Two of the cases were recognized as intraoperative TCR, in the other three cases the cardiovascular effects were possibly due to TCR in one, mechanical stimulation of vital centre in anterior hypothalamus, brainstem, or either mechanical or thermal action of H(2)O(2). CONCLUSIONS According to this two-centre study, we can give, for the first time, evidence that cardiovascular complications according to the intraoperative use of H(2)O(2) in neurosurgery are not rare with an incidence of 3%. Special reference is given to the occurrence of the TCR in this context.