Anaesthetic considerations for management of post covid rhino-orbito-cerebral mucormycosis: Focus on challenges

Abstract

Background and Aims: There has been increasing number of mucormycosis cases as post covid sequalae during second wave of covid pandemic. Our study focussed on challenges in anaesthetic management of surgical resection of post covid rhino-orbito-cerebral mucormycosis. Methods: We did a retrospective case study of 60 patients posted during May-June 2020 posted for surgical resection of Rhino-orbito-cerebral mucormycosis under General Anaesthesia. All patients were operated irrespective of altered laboratory biomarkers, remnant of covid -19 disease. Results: Demographic and clinical parameters, and laboratory biomarkers were reviewed for each patient. Patients had median age of 55 years (23-85 years). Patients belonged to ASA physical status I: II: III (10: 40:10). The most common associated co-morbidity with median elevated Fasting blood sugar level 162 (63-711) followed by hypertension (48%). 85% patients were on steroid therapy (continued from covid disease treatment). 6% were hypothyroid patients. Invasive arterial monitoring was performed in 13.3% patients with femoral central line cannulation done in 85% of cases. 21% patients were shifted to ICU intubated and the rest were shifted with NRBM as a preventive measure. 23% had revision surgery whose mallampatti score was upgraded from I to III. Conclusions: Necessary precautions should be taken for difficult airway caused by fungal debris in oropharyngeal airway and supraglottic edema. So is the importance of Post ICU care because of co-morbidities and post covid sequalae’s.