Cerrahi Debridman Gerektiren Mukormikozis Vakalarına Anestezik Yaklaşım

Abstract

Objective: Mucormycosis is a rare, progressive, and life-threatening fungal infection that occurs in immunocompromised patients. In the present study, we aimed to evaluate the perioperative challenges in the anesthetic management of mucormycosis patients. Methods: Patients over 18 years of age who underwent surgery for mucormycosis within a 3-year period between January 1, 2020 and December 31, 2022 were included in the study. Perioperative records were retrospectively evaluated. Results: During this period, 25 of 47 cases of mucormycosis were surgically treated. Data from these 25 cases were analyzed. Twelve (48%) patients had a diagnosis of rhinocerebral, 7 (28%) rhino-orbital, 5 (20%) rhino-orbito-cerebral and 1 (4%) rhino-pulmonary mucormycosis. All patients had comorbidities. The most common comorbidities were diabetes mellitus in 20 (80%), followed by hypertension in 12 (48%), acute kidney injury in 7 (28%) and coronary artery disease in 5 (20%) patients. Six (24%) patients had a history of COVID-19 infection and were treated with steroids. Intubation was difficult in 2 (8%) patients. Two (8%) patients had intraoperative hemodynamic instability requiring inotropes. There were 17 (68%) patients, 6 (24%) of whom were intubated, who were transferred to the intensive care unit (ICU). The median length of stay in the ICU was 22.7 days and the total length of stay was 42 days. Eleven (44%) patients required mechanical ventilation. Mortality occurred in 12 (48%) patients. Conclusion: Anesthetic management of surgical debridement for mucormycosis is challenging. Challenges include difficult intubation and renal dysfunction. Postoperative follow-up in the ICU is important due to rapid progression and comorbidities. Keywords: Mucormycosis, COVID-19, anesthesia