[Perioperative respiratory problems in patients pretreated with bleomycin]

We examined the incidence of an acute respiratory insufficiency in a retrospective study in 100 patients with carcinomas in the head and neck region who had received cytostatic pretreatment with bleomycin. All patients had been ventilated intraoperatively with 28% to 33% oxygen under precise control of blood gas analysis. In 93% of the patients, there were no respiratory problems in the postoperative course. The total lethality was 7%. Extrapulmonary causes were most prominent in five patients. In one patient, pre-existing pulmonary silicosis was suspected to be the cause of the acute respiratory insufficiency. Only in one patient was the acute respiratory insufficiency refractory to therapy very probably attributable to the synergistic toxic effect of bleomycin and oxygen on the lung parenchyma, as postulated by Goldiner and verified later in animal experiments. On the basis of these results, we do not consider that it is justifiable to reduce categorically the inspiratory oxygen concentration to 21% to 25% oxygen in bleomycin-pretreated patients with tumours in the head and neck region, as recommended by Goldiner. Since the majority are elderly patients with pre-existing cardiopulmonary stress, we recommend moderately reduced oxygen concentrations of 28% to a maximum of 33%. Further recommendations to prevent an acute respiratory insufficiency by those patients are discussed.