We describe the use of nitric oxide as an oxygen-sparing strategy in the context of prior bleomycin exposure. A 27-year-old male, previously treated with bleomycin for a testicular germ cell tumour, presented with severe acute respiratory distress syndrome on the second postoperative day following an extensive retroperitoneal dissection. The mechanism of bleomycin toxicity and potential benefits of nitric oxide in this situation are considered.
DorrR.T.Bleomycin pharmacology: mechanism of action and resistance, and clinical pharmacokinetics.Semin Oncol1992; 19: 3–8.
4.
KanofskyJ.R.Singlet oxygen production by bleomycin. A comparison with heme-containing compounds.J Biol Chem1986; 261: 13546–13550.
5.
ChandlerD.B.Possible mechanisms of bleomycin-induced fibrosis.Clin Chest Med1990; 11: 21–30.
6.
SchmidtR., RuppertC., MarkartP., LubkeN., ErmertL., WeissmannN.Changes in pulmonary surfactant function and composition in bleomycin-induced pneumonitis and fibrosis.Toxicol Appl Pharmacol2004; 195: 218–231.
7.
ComisR.L.Bleomycin pulmonary toxicity: current status and future directions.Semin Oncol1992; 19: 64–70.
8.
O'SullivanJ.M., HuddartR.A., NormanA.R., NichollsJ., DearnaleyD.P., HorwichA.Predicting the risk of bleomycin lung toxicity in patients with germ-cell tumours.Ann Oncol2003; 14: 91–96.
9.
GoldinerP.L., CarlonG.C., CvitkovicE., SchweizerO., HowlandW.Factors influencing postoperative morbidity and mortality in patients treated with bleomycin.Br Med J1978; 1: 1664–1667.
10.
AllenS.C., RiddellG.S., ButchartE.G.Bleomycin therapy and anaesthesia. The possible hazards of oxygen administration to patients after treatment with bleomycin.Anaesthesia1981; 36: 60–63.
11.
DouglasM.J., CoppinC.M.Bleomycin and subsequent anaesthesia: a retrospective study at Vancouver General Hospital.Can Anaesth Soc J1980; 27: 449–452.
12.
HulbertJ.C., GrossmanJ.E., CummingsK.B.Risk factors of anesthesia and surgery in bleomycin-treated patients.J Urol1983; 130: 163–164.
13.
StagosD., KourisS., KouretasD.Plant phenolics protect from bleomycin-induced oxidative stress and mutagenicity in Salmon-ella typhimurium TA102.Anticancer Res2004; 24: 743–745.
14.
HoshinoT., NakamuraH., OkamotoM., KatoS., ArayaS., NomiyamaK.Redox-active protein thioredoxin prevents proinflammatory cytokine- or bleomycin-induced lung injury.Am J Respir Crit Care Med2003; 168: 1075–1083.
15.
GiriS.N.The combined treatment with taurine and niacin blocks the bleomycin-induced activation of nuclear factor-kappaB and lung fibrosis.Adv Exp Med Biol2003; 526: 381–394.
16.
OuryT.D., ThakkerK., MenacheM., ChangL.Y., CrapoJ.D., DayB.J.Attenuation of bleomycin-induced pulmonary fibrosis by a catalytic antioxidant metalloporphyrin.Am J Respir Cell Mol Biol2001; 25: 164–169.
GiriS.N., HollingerM.A.Effect of nordihydroguaiaretic acid and ibuprofen on bleomycin and hyperoxia-induced changes in lung superoxide dismutase, prostaglandins and lethality.Arch Toxicol1996; 70: 271–276.
19.
JensenJ.L., GoelR., VennerP.M.The effect of corticoster-oid administration on bleomycin lung toxicity.Cancer1990; 65: 1291–1297.
20.
WhiteD.A., StoverD.E.Severe bleomycin-induced pneumonitis. Clinical features and response to corticosteroids.Chest1984; 86: 723–728.
21.
RossaintR., FalkeK.J., LopezF., SlamaK., PisonU., ZapolW.M.Inhaled nitric oxide for the adult respiratory distress syndrome.N Engl J Med1993; 328: 399–405.
22.
HaddadE., LowsonS.M., JohnsR.A., RichG.F.Use of inhaled nitric oxide perioperatively and in intensive care patients.Anesthesiology2000; 92: 1821–1825.
DellingerR.P., ZimmermanJ.L., TaylorR.W., StraubeR.C., HauserD.L., CrinerG.J.Effects of inhaled nitric oxide in patients with acute respiratory distress syndrome: results of a randomized phase II trial. Inhaled Nitric Oxide in ARDS Study Group.Crit Care Med1998; 26: 15–23.
25.
WeinbergerB., FakhrzadehL., HeckD.E., LaskinJ.D., GardnerC.R., LaskinD.L.Inhaled nitric oxide primes lung macrophages to produce reactive oxygen and nitrogen intermediates.Am J Respir Crit Care Med1998; 158: 931–938.
26.
KohY., KangJ.L., ParkW., PackI.S., LeeH.S., KimM.J.Inhaled nitric oxide down-regulates intrapulmonary nitric oxide production in lipopolysaccharide-induced acute lung injury.Crit Care Med2001; 29: 1169–1174.
27.
SatoY., WalleyK.R., KlutM.E., EnglishD., D'yachkovaY., HoggJ.C.Nitric oxide reduces the sequestration of polymorphonuclear leukocytes in lung by changing deformability and CD18 expression.Am J Respir Crit Care Med1999; 159: 1469–1476.