Cardiopulmonary Arrest and Pneumoencephaly Developing after Epidural Oxygen-ozone Mixture Therapy
Beyaz SG, Altaş C, Sayhan H. Anesthesia, Essays and Researches, 2018.
- Study type
- Case report
- People studied
- 1 person
- Population
- 79-year-old woman with hypertension, controlled diabetes, and asthma, given epidural oxygen-ozone through a Racz catheter for epidural lysis for low back pain
- Published
- 2018, Anesthesia, Essays and Researches
- Identifiers
- PMID 29628600, DOI 10.4103/aer.AER_142_17
What the authors reported
On the second day of planned epidural oxygen-ozone injections through a Racz catheter, 20 mL (20 μg/mL) was injected instead of the planned 8 mL. Two minutes later the patient lost consciousness and had a cardiopulmonary arrest; sinus rhythm returned after 10 minutes of resuscitation. CT showed widespread intracranial air, which had resolved by day 7. She was extubated on day 4 and discharged.
What limits this result
Single case report. The authors infer from the timing and the imaging that the mixture reached the cranium through the intrathecal route, possibly after the catheter injured the dura. The event followed an accidental injection of 20 mL instead of the planned 8 mL, and no follow-up after discharge is reported.
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How the study was done
- Design
- Case report
Here, we present a case of cardiopulmonary arrest and pneumoencephaly developing after oxygen-O 3 application to the epidural space due to low back pain.
- Setting
- Department of Anesthesiology and Pain Medicine, Sakarya University Training and Research Hospital, Sakarya, Turkey (author affiliation)
- Read from
- Read from the full text of the paper. Read on October 2, 2026.
Study arms
| Group | Participants | What they received |
|---|---|---|
| Single patient | Not reported | Epidural oxygen-ozone injection through a Racz catheter placed at L5-S1 for epidural lysis; on day 2, 20 mL (20 μg/mL) was injected instead of the planned 8 mL |
Source: Full text on PubMed Central
Procedure as reported
- Ozone concentration
- 20 μg/mL
On postoperative day 2, 20 mL −1 (20 μg/mL) of the O 3 -oxygen mixture was placed into a syringe.
- Sessions
- Planned for 3 days (8 mL per injection); the event followed the second day's injection
In the paper's own units, not converted.
Source: Full text on PubMed Central
What it measured
- First day's injection
- Completed easily
- Onset after the second day's injection
- Cardiopulmonary arrest following abrupt loss of consciousness 2 minutes after the injection
- Resuscitation
- Intubated and ventilated with 100% oxygen, given 1 mg adrenaline; normal sinus rhythm after 10 minutes of resuscitation
- Status 2 hours after intubation (intensive care)
- Blood pressure 106/54 mmHg, heart rate 88 bpm, SpO2 97%; general condition moderate, with confusion
- Cranial CT
- Widespread air images in the frontal region of the cingulate gyrus and the left fronto-temporo-parietal region, among other sites
- Extubation and control CT
- Extubated at the end of day 4; the air was completely resorbed on control CT on day 7
She was followed up on mechanical ventilator with proper medication and extubated at the end of the 4 th day; widespread air images were seen to be completely resorbed on control CT on the 7 th day.
- Discharge
- Discharged in good general condition
Source: Full text on PubMed Central
Safety as reported
Cardiopulmonary arrest and pneumoencephaly, which the authors call a rare but life-threatening complication of epidural oxygen-ozone therapyHerein, we present a patient who developed cardiopulmonary arrest and pneumoencephaly as a rare but life-threatening complication of oxygen-ozone therapy, for epidural lysis, applied to the epidural space due to low back pain.
Source: Abstract on PubMed
Funding and conflicts
Supported by Sakarya University, project number 2013-08-06-014
Source: Full text on PubMed Central
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