Background: Bleomycin is a chemotherapeutic agent that has been applied successfully for decades in the treatment of testicular tumors. Case reports and studies in animal models suggest that bleomycin increases the lifelong toxicity of lungs to increased oxygen concentrations, which may trigger ARDS. Therefore, the general recommendation is to keep oxygen levels as low as possible in the context of medical procedures, which opposes the necessity of high oxygen application during one-lung ventilation (OLV).
Case presentation: A 27-year-old male was diagnosed for testicular cancer and treated with five cycles of bleomycin. One year later he underwent open thorax surgery for resection of a large lymphoma in the left thoracic cavity. One-lung ventilation was used, in which one lung is ventilated while the other is allowed to collapse, providing optimal conditions for surgery. Total intravenous anesthesia was perforned, FiO2 was set to 0.23 and a second ventilator was used for high-frequency low-tidal ventilation to result in a ‘collapsed’ left lung. Oxygen saturation remained above 90% and surgery was performed without complications. Recovery of the patient was unremarkable from his extubation to discharge from hospital.
Conclusions: In a patient after bleomycin chemotherapy, an FiO2 of 0.23 and supportive, selective low-tidal high-frequency ventilation of the collapsed lung with a second ventilator may be a viable anesthetic procedure and a trial is justified. Complications during the procedure should be discussed in advance with the team, and the anesthesiologist must be prepared for a sudden transition to regular ventilation of both lungs.