Perioperative Considerations for Patients Treated with Bleomycin (19)

In: Bleomycin

21 Apr 2013

Perioperative Considerations for Patients Treated with Bleomycin (19)Although Goldiner et al recommends limiting crystalloid administration in favor of colloid, there are no reports which show that colloid is superior. Patients should be warned of the possibility of postoperative mechanical ventilation. After surgery the FIo2 should be the lowest required to maintain a target Pa02, and adequate intravascular volume should be maintained. proventil inhaler
Conclusion
It is difficult to formulate definite conclusions on the optimal perioperative management in the bleomycin-treated patient based on the case studies currently in the literature. Many case reports specify FIo2 without indicating the patients Pa02, making it difficult to determine whether a higher FIo2 was necessary to maintain adequate oxygenation in the perioperative period. Some authors indicate that fluid overload may have been a factor in postoperative complications without reporting how much fluid was actually given or the estimated blood loss. The series of Goldiner et al involved patients undergoing retroperitoneal lymph node dissection or thoracotomy, both extensive procedures with the potential for significant fluid shifts. Certainly, aggressive monitoring of fluid status was indicated in these patients but may not be necessary for the patient who presents for a relatively minor procedure after receiving bleomycin.


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