{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T16:17:00Z","timestamp":1780503420143,"version":"3.54.1"},"reference-count":15,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,4,19]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:p>A man in his 20s underwent wound debridement and external fixation for a femoral fracture sustained in a blast injury. Anaesthesia was induced with propofol and nalbuphine and the airway was secured with an i-gel laryngeal mask. About 45\u2009min after induction, irrigation of the semiclosed wound with hydrogen peroxide was followed by a sudden fall in end-tidal carbon dioxide and tachycardia, which progressed rapidly to asystole. Cardiopulmonary resuscitation was started immediately, and tracheal intubation was performed during the first cycle of compressions. Return of spontaneous circulation occurred 6\u2009min later. The patient recovered fully with no neurological or cardiovascular sequelae. The close temporal link between hydrogen peroxide irrigation and circulatory collapse was suggestive of intraoperative oxygen embolism, likely facilitated by oxygen liberation in a confined cavity. This case highlights the need to limit or avoid the use of hydrogen peroxide as irrigant whenever possible, and exercise caution and preparedness whenever its use becomes unavoidable.<\/jats:p>","DOI":"10.1136\/bcr-2025-271477","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T15:55:14Z","timestamp":1780502114000},"page":"e271477","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Suspected venous oxygen embolism following hydrogen peroxide wound irrigation causing intraoperative asystole"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3943-6456","authenticated-orcid":false,"given":"Muhammad Azhar","family":"Sharafat","sequence":"first","affiliation":[{"name":"Anaesthesia, The Aga Khan University Hospital, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zohair Ahmed","family":"Khan","sequence":"additional","affiliation":[{"name":"Anaesthesia, The Aga Khan University Hospital, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Sohaib","sequence":"additional","affiliation":[{"name":"Anaesthesia, The Aga Khan University Hospital, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samie Asghar","family":"Dogar","sequence":"additional","affiliation":[{"name":"Anaesthesia, The Aga Khan University Hospital, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"key":"2026060308550881000_19.6.e271477.1","first-page":"124","article-title":"Gas embolism secondary to intraoperative use of hydrogen peroxide","volume":"44","author":"Garc\u00eda-Velasco","year":"1997","journal-title":"Rev Esp Anestesiol Reanim"},{"key":"2026060308550881000_19.6.e271477.2","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1055\/s-0043-1777810","article-title":"Review of Air Embolism for the Interventional Radiologist","volume":"8","author":"Zangan","year":"2024","journal-title":"Arab J Intervent Radiol"},{"key":"2026060308550881000_19.6.e271477.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2013.01.003"},{"key":"2026060308550881000_19.6.e271477.4","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1016\/j.bjae.2021.04.003","article-title":"Fat embolism syndrome","volume":"21","author":"Luff","year":"2021","journal-title":"BJA Educ"},{"key":"2026060308550881000_19.6.e271477.5","doi-asserted-by":"crossref","first-page":"124","DOI":"10.4103\/0259-1162.108286","article-title":"Anaphylaxis during the perioperative period","volume":"6","author":"Mali","year":"2012","journal-title":"Anesth Essays Res"},{"key":"2026060308550881000_19.6.e271477.6","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.4360"},{"key":"2026060308550881000_19.6.e271477.7","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e31817e2a8c"},{"key":"2026060308550881000_19.6.e271477.8","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1093\/bja\/aew385","article-title":"Primary blast lung injury - a review","volume":"118","author":"Scott","year":"2017","journal-title":"Br J Anaesth"},{"key":"2026060308550881000_19.6.e271477.9","doi-asserted-by":"crossref","first-page":"41","DOI":"10.3126\/noaj.v3i2.9528","article-title":"Oxygen Embolism During Surgical Lavage of Chronic Osteomyelitis of Femur with Hydrogen Peroxide","volume":"3","author":"Rai","year":"2014","journal-title":"Nepal Ortho Assoc J"},{"key":"2026060308550881000_19.6.e271477.10","unstructured":"Mendham J , Denney RC , Barnes JD , et al . 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