Perioperative optimization enhances COVID-19 mucormycosis results

Delta variants of the coronavirus disease (COVID)-19 pandemic are often linked to rhino-orbital cerebral mucormycosis during the second wave of the pandemic. Mucormycosis grew increasingly severe due to a lack of healthcare infrastructure and amphotericin B, necessitating emergency extensive surgical debridement, ocular "exenteration," and maxillectomies.

Recent research examined the perioperative anesthetic care of COVID-19-associated mucormycosis (CAM) patients and described their pre-anesthetic assessment and risk classification for emergency surgical debridement.

The new study involved retrospective data which had 83 patients hospitalized due to COVID-19-associated mucormycosis. With the combination of emergency radical surgical resection and fast beginning of high-dose antifungal medication, the death rate was lowered to 8.9 percent and the length of hospital stay was shortened.

Review of the literature indicates that rhino-orbital cerebral mucormycosis, which is mostly related with COVID-19, has a dismal prognosis. Mucormycosis has historically been linked with significant death rates exceeding 25%. However, our research revealed a lower death rate of 8.9 percent. The post-operative prognosis and increased survival rates in our study's mucormycosis patients were impacted by intensive pre-operative risk assessment, correction of predisposing variables, radical surgical resection, and prompt beginning of high-dose antifungal medication.

Intraoperatively, a stress dose of corticosteroids was administered to all of our patients, regardless of their prior corticosteroid treatment. To maintain intraoperative haemodynamic stability in ASA physical status classes III and IV patients, blood and blood product transfusions and intraoperative inotropes were administered as needed based on the amount of operation and pre-operative abnormalities. The care of perioperative hyperglycemia adhered to the most current standards. According to the recommendations, an antifungal therapy with a high dosage regimen was began promptly. Throughout the intraoperative phase, patients with amphotericin B-related adverse events such as nephrotoxicity, hypokalemia, uncontrolled random blood glucose levels, and diabetic ketoacidosis were rigorously handled medically.

With the assistance of a dedicated CAM care group consisting of anaesthesiologists, surgeons, and intensivists, patients with CAM can achieve superior outcomes in terms of reduced mortality through aggressive pre-operative optimisation, structured anaesthetic management, and careful post-operative planning. Emergency CAM procedures may be aided by a comprehensive clinical evaluation with rapid basic investigations, bedside testing, ABG analysis, and scores such as qSIRS and qSOFA in COVID-19 patients for whom standard protocolized tests are not feasible. This may minimize the time between a patient's hospital admission and surgery, which can enhance patient recovery and survival rates dramatically.

Reference –

Mulakaluri, Amuktamalyada,; Subramanian, Shalini1; P, Subramanya Rao2; Lengade, Pushpa The perioperative anaesthetic management and outcomes of COVID-19 associated mucormycosis patients, Indian Journal of Anaesthesia: May 2022 - Volume 66 - Issue 5 - p 379-383

doi: 10.4103/ija.ija_94_22