Refusing to do Surgery Outpatient due to Bleomycin in 2008

[DowntheRiver]

Hello all -

I was just wondering if any of you could provide evidence of the rationale behind denying somebody the ability to have a kidney stone removed in an outpatient setting under general anesthesia due to having Bleomycin (part of ABVD for Hodgkin's)? No history of previous reaction to anesthesia since having Bleomycin, anesthesiologist just refuses. If you could please provide articles, evidence, or even just a rationale I'd appreciate it.

Thanks!

[KatieMI, BSN, MSN, RN]

While it should be the one to health care provider, according to TOS...

- formal one: risk of chronic pneumonitis, PFT and VQ scan are required to make sure there is no chronic restrictive defect and V/P mismatch. Especially if there was also chest radiation. Anesthesia people hate this combination- and for a whole good row of reasons. It makes all the pharm and patho going through the roof.

- real one: I hear about that stuff first time in my life, and I just heck do not want to deal with it, one way or another. End of discussion.

[MunoRN, RN]

I know there is supposedly increased risk of postoperative respiratory complications in patient's who have received bleomycin, and that it's usually associated with excessive supplemental oxygen peri and postoperatively, so that may be the concern. I guess the main question in an outpatient surgery would be how quickly this becomes apparent after surgery, my impression is that it's immediately obvious post-op, but if a patient could appear to be in-the-clear in first few hours after surgery and then go into respiratory distress more than a few hours later then I could see the anesthesiologist's concern in doing this as an outpatient, where they won't be monitored anymore a few hours after surgery.

Risk factors of anesthesia and surgery in bleomycin-treated patients. - PubMed - NCBI

http://www.anaesthesiawa.org/bleomycin.pdf

[Oh'Ello, BSN, RN]

I know there is supposedly increased risk of postoperative respiratory complications in patient's who have received bleomycin, and that it's usually associated with excessive supplemental oxygen peri and postoperatively, so that may be the concern. I guess the main question in an outpatient surgery would be how quickly this becomes apparent after surgery, my impression is that it's immediately obvious post-op, but if a patient could appear to be in-the-clear in first few hours after surgery and then go into respiratory distress more than a few hours later then I could see the anesthesiologist's concern in doing this as an outpatient, where they won't be monitored anymore a few hours after surgery.

Risk factors of anesthesia and surgery in bleomycin-treated patients. - PubMed - NCBI

http://www.anaesthesiawa.org/bleomycin.pdf

The ARDS actually isn't always immediately apparent, it can manifest to the point of emergency 4-5 days post operatively. At which point that particular patient would likely be far far away from anyone that could intubate them.