Case ReportOxygen-Exacerbated Bleomycin Pulmonary Toxicity
Section snippets
REPORT OF CASE
A previously healthy 28-year-old man sought medical assistance from his local physician on July 4, 1988, because of right-sided chest pain, dysphagia, and severe sore throat. He had a 20-pack-year history of use of tobacco. A chest roentgenogram revealed a right-sided anterior mediastinal mass. A computed tomographic scan of the chest demonstrated multiple pulmonary nodules bilaterally and confirmed the presence of an anterior mediastinal mass. A right thoracotomy was performed. Tissue obtained
DISCUSSION
In 1978, Goldiner and associates7 described five consecutive patients who received 135 to 595 U of bleomycin for testicular cancer and subsequently had adult respiratory distress syndrome that progressed to death within 3 to 5 days after retroperitoneal lymph node biopsy or removal of pulmonary metastatic lesions. During the surgical procedure, they received supplemental oxygen (a mean of 39%; range, 35 to 42%). The operation was performed within 6 to 12 months after bleomycin treatment.
CONCLUSION
The anesthesiologist and the surgeon must be made aware of any history of bleomycin treatment; the clinician must also be certain that the anesthesiologist is familiar with the increased risk of pulmonary injury associated with a fractional concentration of oxygen in inspired gas of more than 0.3 and prior bleomycin treatment. Our case is similar to other cases of respiratory failure attributed to oxygen-exacerbated bleomycin toxicity reported in the literature. A surgical procedure before the
ACKNOWLEDGMENT
We thank Thomas V. Colby, M.D., for interpreting the pathologic specimens and Sharon M. Peterson, Patricia A. Muldrow, and Lori L. Oeltjenbruns for secretarial assistance in preparing the submitted manuscript.
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2022, Biomedicine and PharmacotherapyCitation Excerpt :Those with baseline shortness of breath at rest may not be ideal candidates for surgery and will require medical optimization before undergoing surgery [10,16]. Surgery also may need to be postponed if high concentrations of inspired oxygen are required for patients with recent bleomycin treatment as case reports have shown hyperoxia (inspiratory oxygen fraction > 30%) in these patients may increase the risk of acute respiratory failure [24,25]. Patients with chemotherapy-induced myelosuppression are ideal candidates for all surgeries if their platelet count exceeds 100,000/mm3 and neutropenia is absent.
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2018, Free Radical Biology and MedicineCitation Excerpt :Additionally, under radical or O2 overload, this pathway can also be expected to play a role in the onset of CBZ-induced adverse events. Namely, a similar effect to what is observed with bleomicyn [53] can be anticipated for CBZ-induced pulmonary toxicity. This antineoplastic agent induces pulmonary injury, attributed in part to disruption of the thiol redox status in the lungs (lung epithelial cells), that is increased with the administration of O2.