Urgent ERCP with Bleomycin Lung Toxicity

You are on-call at a tertiary hospital and receive a theatre booking from a surgeon at 23:00 hours for an urgent endoscopic retrograde cholangiopancreatography (ERCP). The patient is a 30-year-old male (weight 60 kg) who presented with a three-day history of vomiting and jaundice and has been diagnosed with ascending cholangitis due to choledocholithiasis. He is febrile at 38.5°C and tachycardic at 110 bpm. His past medical history includes stage III testicular cancer diagnosed 12 years ago, for which he underwent radical orchidectomy followed by 18 months of chemotherapy with bleomycin and cisplatin. During his latest surveillance review with oncology he was sent for some further investigations to assess progressive shortness of breath. His pulmonary function tests and chest X-ray are provided. Pulmonary Function Test results show a restrictive pattern with significantly reduced gas transfer capacity (TLCO 26% predicted, KCO 39% predicted).