Pulmonary mucormycosis: An anaesthesiologist's perspective

Abstract

Introduction: As a frontline warrior, every anesthesiologist is fighting the coronavirus 2019 (COVID-19) pandemic to save lives, but at the same time, post-COVID sepsis has emerged as a serious challenge opening a new battlefield for corona warriors. In recent times, mucormycosis, a rare opportunistic fungal infection, has emerged as a serious and life-threatening disease that is spreading rapidly, leading to tissue infarction and necrosis in post-COVID patients; hence, quick recognition of this potentially lethal disease and early treatment is of paramount importance in reducing the mortality rate. Methods: The aim of this review article was to summarise the literature on anesthestic management of pulmonary mucormycosis (PM) patients undergoing thoracotomy surgery. Searches had been conducted in Google Scholar, Wiley online library, National Library of Medicine, PubMed, Scopus, Excerpta Medica Database and Cochrane Library using the following keywords: lung, mucormycosis, anaesthesia, presurgical, intraoperative, postsurgical and their permutations. Results: The true frequency of mucormycosis in India is still unknown; however, it is found to be consequentially more than in Western nations. PM has a high mortality rate, which is attributable in part to its locally aggressive nature and in part to the underlying risk factors; however, this rate has improved over time due to advancements in diagnostic techniques. Conclusion: Management of PM must be approached with a multifaceted, assertive plan. Early identification of infection, reversal of the prevailing risk factors, surgical elimination of contaminated tissue and medical management by antimycotic agents are the four critical steps in the management of mucormycosis. The key to a successful operation was a thorough pre-operative assessment, proper pre-operative preparation and much clinical surgical expertise.