Bleomycin and perioperative care: a case report

Main Article Content

B Jayakrishnan
Rajini Kausalya
Hilal A Al-Rashdi
Kirubakaran Davis
Jahfar Ali
Munjid Al-Harthy
Sami M Bennji

Keywords

Bleomycin, Cancer, Oxygen, Perioperative care, Pulmonary toxicity

Abstract

 Bleomycin is associated with pulmonary toxicity ranging from pneumonitis, pulmonary fibrosis, to fatal acute respiratory distress syndrome. Oxygen administration can potentiate or precipitate bleomycin pulmonary toxicity, and the most common setting of oxygen exposure is during anesthesia. We report here the successful management and perioperative care of a patient with documented bleomycin pulmonary toxicity who had to undergo an eight hour long retroperitoneal surgery. With proper preoperative assessment, chest physiotherapy, inhaled steroids and bronchodilators, antibiotics, operative restriction of oxygen and fluids and good postoperative care no further pulmonary insult was inflicted.

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References

1. Stephens M, Murphy T, Hendry D. Anaesthesia for retroperitoneal lymph node dissection in the treatment of testicular cancer. BJA Educ. 2019;19:283–9.
2. Wuethrich PY, Burkhard FC. No Perioperative pulmonary complications after restricted oxygen exposition in bleomycin-treated patients: A short report. ISRN Anesthesiol. 2011;2011:1–3.
3. Goldiner PL, Carlon GC, Cvitkovic E, Schweizer O, Howland WS. Factors influencing postoperative morbidity and mortality in patients treated with bleomycin. Br Med J. 1978 ;1 (6128):1664–7.
4. Gilson AJ, Sahn SA. Reactivation of bleomycin lung toxicity following oxygen administration. Chest. 1985;88:304–6.
5. Aakre BM, Efem RI, Wilson GA, Kor DJ, Eisenach JH. Postoperative acute respiratory distress syndrome in patients with previous exposure to bleomycin. Mayo Clin Proc. 2014;89:181–9.
6. Donat SM, Levy DA. Bleomycin associated pulmonary toxicity: is perioperative oxygen restriction necessary? J Urol. 1998;160:1347–52.
7. LaMantia KR, Glick JH, Marshall BE. Supplemental oxygen does not cause respiratory failure in bleomycin-treated surgical patients. Anesthesiology. 1984;60:65–6.
8. Waid-Jones MI, Coursin DB. Perioperative considerations for patients treated with bleomycin. Chest. 1991;99:993–9.
9. Ingrassia TS, Ryu JH, Trastek VF, Rosenow EC. Oxygen-exacerbated bleomycin pulmonary toxicity. Mayo Clin Proc. 1991;66:173–8.
10. Patel NM, Kulkarni T, Dilling D, Scholand MB, Gupta N, Strek M, et al. Preoperative evaluation of patients with interstitial lung disease. Chest. 2019;156:826–33.
11. Gao S, Barello S, Chen L, Chen C, Che G, Cai K, et al. Clinical guidelines on perioperative management strategies for enhanced recovery after lung surgery. Transl Lung Cancer Res. 2019;8:1174–87.
12. Zhu X, Zhang P, Lou C, Wu J. Perioperative inhaled corticosteroids treatment is associated with decreased length-of-stay and direct medical costs in high-respiratory-risk surgeries. J Med Econ. 2020;23:280–6.

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