第二波COVID-19大流行期间鼻-眶-脑毛霉菌病患者围手术期麻醉的挑战和结局:一项观察性研究

IF 16.4 1区 化学 Q1 CHEMISTRY, MULTIDISCIPLINARY
Accounts of Chemical Research Pub Date : 2023-10-01 Epub Date: 2023-05-31 DOI:10.4103/joacp.joacp_169_22
Kamlesh Kumari, Darshana Rathod, Tanvi Meshram, Sadik Mohammed, Sachith Raju, Ankur Sharma, Bikram Chaudhary, Pradeep Bhatia
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引用次数: 0

摘要

背景和目的:据报道,在 COVID 第二波期间,鼻-眼-脑粘液瘤病(ROCM)病例迅速激增,尤其是在印度,需要进行广泛的手术清创和药物治疗。本研究计划观察 COVID-19 第二波大流行期间 ROCM 患者围手术期的麻醉挑战和结果。首要目标是观察术中麻醉挑战,次要目标是观察患者术后挑战和结果:这是一项单中心、双向(回顾性和前瞻性)观察研究,在一家三级医疗中心进行。我们招募了 218 名成人患者,计划在全身麻醉下对 ROCM 进行手术清创。研究记录了患者的人口统计学特征、COVID 状态、合并症、术中挑战(困难气道、血流动力学不稳定、失血)和术后结果(术后机械通气和死亡率):大多数患者为男性(71%)和糖尿病患者(54%)。67%的患者患有与COVID相关的粘液瘤病,41%的患者接受了类固醇治疗。20.6%的患者术后出现低血压,14.2%的患者术中出现低血压,其中5.5%的患者需要血管加压支持。分别有 7.3% 和 6.4% 的患者出现面罩通气困难和插管困难。COVID 粘液瘤病与非 COVID 粘液瘤病相比,术中遇到的困难没有明显差异。41.3%的患者术后需要机械通气和重症监护室护理,11.5%的患者出现死亡。COVID粘液瘤患者的死亡率(13%)明显高于非COVID粘液瘤患者(4.2%)(P = 0.041):结论:在COVID期间接受类固醇治疗的男性糖尿病患者罹患ROCM的风险最高。气道困难和血流动力学不稳定是麻醉医生在围手术期遇到的重大挑战。术后重症监护室的管理对于降低术后发病率和死亡率至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Perioperative anesthesia challenges and outcomes of patients with Rhino-Orbito-Cerebral Mucormycosis during the second wave of COVID-19 pandemic: An observational study.

Background and aims: A rapid surge in rhino-orbito-cerebral mucormycosis (ROCM) cases was reported during the second wave of COVID, especially in India, needing extensive surgical debridement along with medical management. The present study was planned to observe perioperative anesthesia challenges and outcomes of patients with ROCM during the second wave of the COVID-19 pandemic. The primary objective was to observe intraoperative anesthesia challenges and the secondary objectives were to observe postoperative challenges and outcomes of patients.

Material and methods: This was a single-centered, bidirectional (retrospective and prospective) observational study, conducted at a tertiary care center. We enrolled 218 adult patients scheduled for surgical debridement of ROCM under general anesthesia. Demographics, COVID status, comorbid illness, intraoperative challenges (difficult airway, hemodynamic instability, blood loss), and postoperative outcome (postoperative mechanical ventilation, and mortality rate) were noted.

Results: The majority of the patients were males (71%) and had diabetes mellitus (54%). COVID-associated mucormycosis was seen in 67% and 41% of them received steroids. Post-induction hypotension was noted in 20.6% of patients, and 14.2% had intraoperative hypotension out of which 5.5% required vasopressor support. Difficult mask ventilation and difficult intubation were reported in 7.3% and 6.4% of patients, respectively. No significant difference was found among intraoperative challenges when COVID mucormycosis was compared to non-COVID mucormycosis. Postoperative mechanical ventilation and ICU care were required in 41.3%, whereas mortality was seen in 11.5% of patients. The mortality was significantly more (P = 0.041) in patients with COVID mucormycosis (13%) compared to that with non-COVID mucormycosis (4.2%).

Conclusion: Diabetic male patients who received steroids during COVID illness are at the highest risk of developing ROCM. Difficult airway and hemodynamic instability, are significant perioperative challenges encountered by anesthesiologists. Postoperative ICU management is crucial for decreasing postoperative morbidity and mortality.

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来源期刊
Accounts of Chemical Research
Accounts of Chemical Research 化学-化学综合
CiteScore
31.40
自引率
1.10%
发文量
312
审稿时长
2 months
期刊介绍: Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.
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