Challenges of Anaesthetic Management in Endoscopic Sinus Surgery in Post COVID Rhino Orbital Cerebral Mucormycosis Patients
Article Sidebar
Main Article Content
Abstract
Introduction
Mucormycosis is a potentially lethal opportunistic, angioinvasive fungal infection with rapid progression and high mortality and predisposed by diabetes mellitus, corticosteroid other immunosuppressive drugs, haematological malignancies, haematological stem cell transplantation, solid organ transplantation and iron overdose. The aim of our study is to consider the challenge in providing anaesthesia in endoscopic sinus surgery for rhino orbital cerebral mucormycosis in post COVID patient.
Materials and Methods
A total of 20 patients after being COVID negative, posted for endoscopic debridement of paranasal sinuses and also of orbital contents were analysed with respect to outcome after surgery considering the comorbidities of the patients and toxic effect of antifungal drug. Patients’ comorbidities were optimised through preoperative evaluation prior to surgery. Adequate monitoring of haemodynamic status during intraoperative period and optimum anaesthetic management was provided in endoscopic sinus surgery. The patients were managed in recovery room in post operative period and their outcome was reviewed.
Results
Our patients posed 3 challenges: a) difficult airway in view of palatal perforation b) long standing diabetes mellitus with associated metabolic complications c) administration of amphotericin B could interact with anaesthetic agents and produced adverse outcome. After surgery mortality was experienced in 10% of cases.
Conclusion
Awareness of warning symptoms and signs, a high index of suspicion, early diagnosis and initiation of full dose of liposomal Amphotericin B and meticulous surgical management may help to optimise the outcome of ROCM in the setting of COVID 19 infection.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
References
Skiada A, Pavleas I, Drogari-Apiranthitou M. Epidemiology and Diagnosis of Mucormycosis: An Update. J Fungi (Basel). 2020; 6(4):265
Ahuja V, Kazal S, Sinha S. Palatal obturator: Perioperative concerns. Indian Journal of Anaesthesia. 2014; 58(1):87-9
Kulkarni PK, Reddy NB, Shrinivas B, Takkalki VV. Anesthetic considerations in the management of mucormycosis. Int J Med Public Health 2015; 5:387-90
Chen N., Zhou M., Dong X., Qu J., Gong F., Han Y. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395: 507-13
Petrikkos G., Skiada A., Lortholary O., Roilides E., Walsh T.J., Kontoyiannis D.P. Epidemiology and clinical manifestations of mucormycosis. Clin Infect Dis. 2012; 54:23-34
Song G., Liang G., Liu W. Fungal Co-infections associated with global COVID-19 Pandemic : a clinical and diagnostic perspective from China. Mycopathologia. 2020;185(4):599-606
Farmakiotis D., Kontoyiannis D.P. Mucormycoses. Infect Dis Clin North Am. 2016;30:143-63
Honavar SG. Code Mucor: Guidelines for the Diagnosis, Staging and Management of RhinoOrbito-Cerebral Mucormycosis in the Setting of COVID-19. Indian J Ophthalmol. 2021; 69:1361-5
Nehara HR, Puri I, Singhal V, Ih S, Bishnoi BR, Sirohi P. Rhinocerebral mucormycosis in COVID-19 patient with diabetes a deadly trio: Case series from the north-western part of India. Indian J Med Microbiol. 2021; 39(3):380-3
Imhof A, Walter RB, Schaffner A. Continuous infusion of escalated doses of amphotericin B deoxycholate: an open-label observational study. Clin Infect Dis. 2003; 36(8):943-51.