Perioperative management of patients with post Covid rhino-orbito-cerebral mucormycosis: Prospective observational study

Abstract

Mucormycosis is a life-threatening, locally invasive, rapidly progressive, opportunistic fungal infection, associated with several anaesthetic challenges. We aimed to study its relation with patient’s comorbidities, covid treatment strategies, also to observe the intubation difficulties, changes in hemodynamic parameters, post anaesthesia recovery status and perioperative complications. In this time bound study, total 160 patients were included. During pre-anaesthetic evaluation, presence of associated co-morbidities, course of Covid-19 disease, requirement of O2 therapy were noted. On the day of surgery, premedications and sedation were given. Induction was done with propofol/etomidate along with sevoflurane/desflurane. Intubation was done with succinyl choline/ atracurium and difficulties in intubation were graded according to Modified Intubation Difficulty Scale. Anaesthesia was maintained with the mixture of Oxygen, Air and inhalation agent along with intermittent Atracurium. Hemodynamic parameters, intra operative and post operative outcome were noted. Unstable patients were shifted to intensive care unit. Among patients of rhino-orbito-cerebral mucormycosis, most common co morbidity found was diabetes mellitus (42%). Here, 61% were on room air, rest needed oxygen therapy. Total 52% patients required >/= 2 intubation attempts, in which 9% were video laryngoscope assisted and 11% required additional maneuvers. 22% patients were started on intravenous nitroglycerin to manage intraoperative hypertension. 9.3% patients required ICU admission, of which 2.5% could not survive. Possibilities of developing rhino-orbito-cerebral mucormycosis in patients having diabetes mellitus are high. The anaesthetic management requires eternal vigilance to encounter difficult intubation, delayed recovery, and higher rate of morbidity and mortality.