1/4. bleomycin and scuba diving: to dive or not to dive?bleomycin is to treat patients with testicular cancer and lymphoma. bleomycin can bind to dna and chelate iron. The resulting complex can form an intermediate capable of interacting with oxygen to produce reactive oxygen species, particularly superoxide. Administrating high-inspired oxygen concentrations (e.g. during anaesthesia or acute illness) has been reported to exacerbate pulmonary injury. The duration of risk after bleomycin chemotherapy is unknown. Here we discuss our advice to a young male patient, who was successfully treated with bleomycin for testicular cancer, concerning the safety to return to scuba diving. Since scuba divers are exposed to high partial oxygen pressures (depending on the depth of the dive) we discouraged this patient from resuming scuba diving.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/4. bleomycin and subsequent anaesthesia: a retrospective study at Vancouver General Hospital.A retrospective review was made of 20 surgical procedures in 14 patients with testicular carcinoma, previously treated with bleomycin chemotherapy, to evaluate the incidence of postoperative pulmonary complications. Other studies have suggested an increased rate of pulmonary complications, including fatal respiratory failure, when inspired oxygen fraction (FIO2) exceeds 0.3 during or after operation. There is a suggestion that bleomycin may sensitize the lungs to the effect of oxygen, leading to oxygen toxicity. This study involved patients whose inspired oxygen fraction ranged from 0.3 to 1.0 and only one non-fatal pulmonary complication occurred. The risks of anaesthesia following bleomycin are discussed with particular reference to possible enhanced oxygen toxicity.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
3/4. bleomycin therapy and anaesthesia. The possible hazards of oxygen administration to patients after treatment with bleomycin.bleomycin is a cytotoxic drug used in the treatment of teratoma of the testis. This drug appears to sensitize the lungs so that acute lung damage occurs with concentrations of oxygen normally considered free from toxic effects. Two anaesthetics administered to the same patient undergoing thoracotomy are reported. No postoperative lung damage was produced on either occasion.- - - - - - - - - - ranking = 4keywords = anaesthesia (Clic here for more details about this article) |
4/4. Spinal artery syndrome masked by postoperative epidural analgesia.PURPOSE: We report a case of a patient who developed a postoperative anterior spinal artery syndrome that was masked by the use of epidural analgesia. We wish to alert other anaesthetists that the use of epidural anaesthesia in this setting may mask the symptoms and delay the diagnosis of this rare complication. CLINICAL FEATURES: The patient was a 22-yr-old obese man with metastatic testicular carcinoma who underwent a left-sided thoracoabdominal retroperitoneal tumour resection. A lumbar epidural catheter was placed preoperatively for pain management. Postoperatively, the patient developed bilateral lower extremity weakness, which was at first attributed to epidural administration of local anaesthetics. Despite discontinuation of the local anaesthetics, the symptoms persisted. Further work-up led to the diagnosis of anterior spinal artery syndrome. The patient was sent to a rehabilitation hospital and had a partial recovery. CONCLUSION: anterior spinal artery syndrome can occur following retroperitoneal surgery. It is important to recognize the potential for this complication when postoperative epidural analgesia is contemplated, especially following a left-sided surgical dissection. The use of epidural local anaesthetics immediately after surgery delays the diagnosis of a postoperative neurological deficit. Moreover, when the deficit is recognized the epidural itself may be falsely blamed for postoperative paraplegia. If epidural analgesia is used, opioids may be preferred over local anaesthetics in the immediate postoperative period to prevent masking of an anterior spinal artery syndrome.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |