Anesthesia management of patients posted for resection of rhino-orbital mucormycosis developed as a postCovid sequale: Sharing our experiences

Abstract

Background: Although Mucormycosis is a rare life-threatening fungal infection mainly seen in immunocompromised patients, there has been increasing number of mucormycosis cases presenting as a post COVID sequale mainly from India.  Uncontrolled diabetes and overzealous use of steroid seems to be two main aggravating factors. Aggressive medical and surgical management of mucormycosis decreases mortality rate from 88% to 21%. Aim: This study is aimed to evaluate anaesthetic challenges in the post COVID patients coming for surgical clearance of mucormycosis. Demographic characteristics, associated comorbidities, procedural data, surgical details, hospital stay and mortality rates were reviewed in 32 patients. The mean age of our patients was 52.66 yrs. and 96.9% had associated comorbidities. Two (6.3%) patients had mallampati classification (MPC) IV and 12 had III (40.6%). Average anaesthesia duration was 282.5 min with mean blood loss 792 ml. Twenty-one (65.6%) patients were shifted to ICU (intensive care unit) out of which 15 (46.87%) were electively ventilated. Mortality was seen in 2 patients with mortality rate of 6.25%. Conclusion: Surgical resection of mucormycosis in post covid patients presents unique challenges – associated comorbidities, difficult airway, prolonged surgical duration, intraoperative hemodynamic instability massive blood loss, Amphotericin B related side effects mainly nephrotoxicity and hypokalemia, need for postoperative ventilation and prolonged hospital stay. Preoperative optimization, careful intraoperative monitoring and postoperative management are necessary for better outcome.