In: Bleomycin22 Apr 2013
A valuable approach to the resolution of these questions may be a multicenter clinical study of all patients who come to surgery after receiving bleomycin. Because most of the case reports in the literature involve either complications or major surgical procedures, it would be helpful to study outcomes for all types of surgery in a large number of patients. Such a study would require the participation of five to ten centers which are active in genitourinary oncologic care and clinical research. This study should include the retrospective review of the records of 200 to 400 patients who have been treated with bleomycin and then had surgery. With a reported incidence of bleomycin-induced fibrosis of 11 to 30 percent, one would expect to see sufficient numbers of patients with diseased lungs to determine whether acute exacerbations occur after surgery and whether these exacerbations correlate with the FIo2. It seems likely that two subgroups might emerge: (1) those patients having surgery prior to the publication of the recommendations of Goldiner et al (presumably with higher levels of FIo2); and (2) those having surgery after limitation of the FIo2 became standard practice. ventolin 100 mcg
A subsequent prospective study could document the postoperative course of 200 to 300 bleomycin-treated patients who undergo anesthesia using the current recommendations of limiting FIo2 to maintain a target Pa02. Presumably, some patients in the study would require levels of FIo2 higher than those currently recommended to maintain an adequate Pa02, and their course could be compared to those in the former group. Such a study would be subject to the intrinsic bias and to the difficulty in controlling the many variables in perioperative care which are inherent in all large clinical studies. In addition, exclusion criteria for surgery may have prevented those patients with significant lung compromise from having surgery at all; however, this approach would have the potential to study sufficient numbers of patients to generate more meaningful recommendations for anesthetic and postoperative management.
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