Bleomycin and perioperative care: a case report

Bleomycin and perioperative care: a case report

Authors

  • B Jayakrishnan Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman.
  • Rajini Kausalya Sultan Qaboos Comprehensive Cancer Care &Research Centre
  • Hilal A Al-Rashdi Sultan Qaboos Comprehensive Cancer Care &Research Centre,Muscat,Oman
  • Kirubakaran Davis Sultan Qaboos Comprehensive Cancer Care &Research Centre
  • Jahfar Ali Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman.
  • Munjid Al-Harthy Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman.
  • Sami M Bennji Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman.

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.

Author Biographies

B Jayakrishnan, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman.

Senior Consultant, Division of Pulmonology, Head &Neck and Thoracic Program,

Rajini Kausalya , Sultan Qaboos Comprehensive Cancer Care &Research Centre

Senior Consultant, Department of Anaesthesia

Hilal A Al-Rashdi, Sultan Qaboos Comprehensive Cancer Care &Research Centre,Muscat,Oman

Consultant Urologist, Genitourinary Program

Kirubakaran Davis , Sultan Qaboos Comprehensive Cancer Care &Research Centre

Consultant, Department of Anaesthesia

Jahfar Ali, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman.

Specialist, Department of Anaesthesia

Munjid Al-Harthy , Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman.

6Consultant Oncologist, Genitourinary Program

Sami M Bennji, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman.

Consultant, Division of Pulmonology, Head &Neck and Thoracic Program

References

Stephens M, Murphy T, Hendry D. Anaesthesia for retroperitoneal lymph node dissection in the treatment of testicular cancer. BJA Educ. 2019;19:283–9.

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.

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.

Gilson AJ, Sahn SA. Reactivation of bleomycin lung toxicity following oxygen administration. Chest. 1985;88:304–6.

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.

Donat SM, Levy DA. Bleomycin associated pulmonary toxicity: is perioperative oxygen restriction necessary? J Urol. 1998;160:1347–52.

LaMantia KR, Glick JH, Marshall BE. Supplemental oxygen does not cause respiratory failure in bleomycin-treated surgical patients. Anesthesiology. 1984;60:65–6.

Waid-Jones MI, Coursin DB. Perioperative considerations for patients treated with bleomycin. Chest. 1991;99:993–9.

Ingrassia TS, Ryu JH, Trastek VF, Rosenow EC. Oxygen-exacerbated bleomycin pulmonary toxicity. Mayo Clin Proc. 1991;66:173–8.

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.

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.

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.

Downloads

Published

13-09-2023

Issue

Section

Case Reports

How to Cite

1.
Jayakrishnan B, Kausalya R, Al-Rashdi HA, Davis K, Ali J, Al-Harthy M, et al. Bleomycin and perioperative care: a case report. Sarcoidosis Vasc Diffuse Lung Dis [Internet]. 2023 Sep. 13 [cited 2025 Apr. 10];40(3):e2023030. Available from: https://mattioli1885journals.com/index.php/sarcoidosis/article/view/14385