Hydrogen peroxide: reminder of risk of gas embolism when used in surgery

Do not use in closed body cavities or on deep or large wounds.

Hydrogen peroxide is indicated at concentrations of up to 6% for disinfection of minor cuts, wounds and skin ulcers. It is also indicated at a concentration of 1.5% as a mouthwash or gargle.

We remind you that the use of hydrogen peroxide in closed body cavities and deep or large wounds is contraindicated. Hydrogen peroxide breaks down rapidly to water and oxygen on contact with tissues. If this reaction occurs in an enclosed space, the large amount of oxygen produced can cause gas embolism.

In May 2014 we received a Yellow Card report of gas embolism linked to the use of hydrogen peroxide in surgery. We are also aware of several case reports that have been published from around the world of life threatening or fatal gas embolism with use of hydrogen peroxide in surgery, of which five were from the UK. Most of the global reports describe cardiorespiratory collapse occurring within seconds to minutes of instillation of hydrogen peroxide as wound irrigation or when used to soak swabs for wound packing.1 2 3 4 5 6 This was sometimes accompanied by features associated with excess gas generation such as surgical emphysema,3 pneumocephalus,6 aspiration of gas from central venous lines,4 or the presence of gas bubbles on transoesophageal echocardiography.1 Non-fatal events were sometimes associated with permanent neurological damage such as neuro-vegetative state and hypoxic encephalopathy.

Advice for healthcare professionals:

  • do not use hydrogen peroxide during surgery - it is contraindicated for use in closed body cavities or on deep or large wounds due to the risk of gas embolism

Further information

Hydrogen peroxide summaries of product characteristics

Article citation: Drug Safety Update volume 8 issue 5, December 2014: A4

  1. Dubey et al. Anesth Analg 2002; 95(2): 497.

  2. Haller et al. Br J Anaesth 2002; 88(4): 597-9.

  3. Henley et al. J Bone Joint Surg Am 2004; 86-A(4): 821-2.

  4. Ahluwalia et al. Injury Extra 2006; 37: 139-40.

  5. Beattie et al. J Plast Reconstr Aesthet Surg 2010; 63(3): e253-4.

  6. Chhabra et al. Br J Neurosurg 2000; 4(6):549-51.

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