Perioperative anesthetic concerns in postcovid mucormycosis patients posted for surgical intervention: An observational Study
Background: COVID 19 pandemic caused by severe acute respiratory syndrome coronavirus -2 has proven to be the deadliest pandemic till date. Multiple covid waves have hit people hard on each part of the continent throughout the world. The second wave in India turned out to be highly infectious and vi...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2022-01-01
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| Series: | Saudi Journal of Anaesthesia |
| Subjects: | |
| Online Access: | http://www.saudija.org/article.asp?issn=1658-354X;year=2022;volume=16;issue=2;spage=176;epage=181;aulast=Misra |
| _version_ | 1819062093667631104 |
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| author | Shilpi Misra Shivani Rastogi Deepak Malviya Rachana Gupta Sandeep K Yadav Sharif Alam |
| author_facet | Shilpi Misra Shivani Rastogi Deepak Malviya Rachana Gupta Sandeep K Yadav Sharif Alam |
| author_sort | Shilpi Misra |
| collection | DOAJ |
| description | Background: COVID 19 pandemic caused by severe acute respiratory syndrome coronavirus -2 has proven to be the deadliest pandemic till date. Multiple covid waves have hit people hard on each part of the continent throughout the world. The second wave in India turned out to be highly infectious and virulent. Sudden surge in cases of mucormycosis after recovery of COVID surprised many clinician. Mucormycosis being a rapidly progressive and fulminant fungal infection required surgical debridement of necrotic tissue on emergency basis. The fatal combination of immunocompromised status, multisystemic involvement, and difficult airway in these patients pose numerous new challenges regarding anesthetic management. The present study was conducted to outline major concerns and the anesthetic management of patients undergoing surgical resection for rhinoorbital mucormycosis (ROM).
Materials and Methods: A retrospective observational study was conducted in our institute for a duration of 2 months (June and July 2021). The data of all the cases posted for ROM was collected from the ENT and Anesthesia record register. Total 70 patients presented with mucormycosis, for surgical debridement out of which 25 patients were posted for surgery under general anesthesia or monitored anesthesia care (MAC). Demographic characteristics, comorbidities, duration of COVID illness, treatment taken during COVID (oxygen therapy/steroid intake), hemodynamic parameters, monitoring methods, and surgical procedures were recorded for each patient.
Statistical Evaluation: SPSS version 21.0 was used for data analysis. Mean and SD were used to analyze the difference in mean values, and independent Student's t-test were utilized to compare the quantitative variables. Frequency distribution and percentage were used for qualitative parameters. Significant difference was accepted at P ≤ 0.05 with 95% CI (confidence interval) in the study.
Results: Demographic data were comparable with respect to age, gender distribution, and ASA status. Mean duration of Covid illness was (12.18 ± 3.68) days. The mean HbA1C measured was (10.8 ± 1.42). Strong correlation was found between steroid intake and raised HbA1c in all patients (r = 0.77). Regarding the comorbidities, 24 (96%) patients had associated type 2 diabetes mellitus, 16 patients (64%) had pneumonitis, and 1 patient had pulmonary TB and hepatitis.
Conclusion: Considering the perioperative risk associated with high HbA1C and pneumonitis, MAC was preferred in majority of cases. Strict hemodynamic monitoring, perioperative glucose control, difficult airway cart, metabolic and electrolyte balance and vigilant peri-operative monitoring are cornerstone for better outcome and short length of hospital stay. |
| first_indexed | 2024-12-21T14:53:18Z |
| format | Article |
| id | doaj.art-fbce6cdd4f1f411db4b15be31f9e7717 |
| institution | Directory Open Access Journal |
| issn | 1658-354X |
| language | English |
| last_indexed | 2024-12-21T14:53:18Z |
| publishDate | 2022-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Saudi Journal of Anaesthesia |
| spelling | doaj.art-fbce6cdd4f1f411db4b15be31f9e77172022-12-21T18:59:50ZengWolters Kluwer Medknow PublicationsSaudi Journal of Anaesthesia1658-354X2022-01-0116217618110.4103/sja.sja_783_21Perioperative anesthetic concerns in postcovid mucormycosis patients posted for surgical intervention: An observational StudyShilpi MisraShivani RastogiDeepak MalviyaRachana GuptaSandeep K YadavSharif AlamBackground: COVID 19 pandemic caused by severe acute respiratory syndrome coronavirus -2 has proven to be the deadliest pandemic till date. Multiple covid waves have hit people hard on each part of the continent throughout the world. The second wave in India turned out to be highly infectious and virulent. Sudden surge in cases of mucormycosis after recovery of COVID surprised many clinician. Mucormycosis being a rapidly progressive and fulminant fungal infection required surgical debridement of necrotic tissue on emergency basis. The fatal combination of immunocompromised status, multisystemic involvement, and difficult airway in these patients pose numerous new challenges regarding anesthetic management. The present study was conducted to outline major concerns and the anesthetic management of patients undergoing surgical resection for rhinoorbital mucormycosis (ROM). Materials and Methods: A retrospective observational study was conducted in our institute for a duration of 2 months (June and July 2021). The data of all the cases posted for ROM was collected from the ENT and Anesthesia record register. Total 70 patients presented with mucormycosis, for surgical debridement out of which 25 patients were posted for surgery under general anesthesia or monitored anesthesia care (MAC). Demographic characteristics, comorbidities, duration of COVID illness, treatment taken during COVID (oxygen therapy/steroid intake), hemodynamic parameters, monitoring methods, and surgical procedures were recorded for each patient. Statistical Evaluation: SPSS version 21.0 was used for data analysis. Mean and SD were used to analyze the difference in mean values, and independent Student's t-test were utilized to compare the quantitative variables. Frequency distribution and percentage were used for qualitative parameters. Significant difference was accepted at P ≤ 0.05 with 95% CI (confidence interval) in the study. Results: Demographic data were comparable with respect to age, gender distribution, and ASA status. Mean duration of Covid illness was (12.18 ± 3.68) days. The mean HbA1C measured was (10.8 ± 1.42). Strong correlation was found between steroid intake and raised HbA1c in all patients (r = 0.77). Regarding the comorbidities, 24 (96%) patients had associated type 2 diabetes mellitus, 16 patients (64%) had pneumonitis, and 1 patient had pulmonary TB and hepatitis. Conclusion: Considering the perioperative risk associated with high HbA1C and pneumonitis, MAC was preferred in majority of cases. Strict hemodynamic monitoring, perioperative glucose control, difficult airway cart, metabolic and electrolyte balance and vigilant peri-operative monitoring are cornerstone for better outcome and short length of hospital stay.http://www.saudija.org/article.asp?issn=1658-354X;year=2022;volume=16;issue=2;spage=176;epage=181;aulast=Misraanesthetic concernspostcovidrhinoorbital mucormycosis |
| spellingShingle | Shilpi Misra Shivani Rastogi Deepak Malviya Rachana Gupta Sandeep K Yadav Sharif Alam Perioperative anesthetic concerns in postcovid mucormycosis patients posted for surgical intervention: An observational Study Saudi Journal of Anaesthesia anesthetic concerns postcovid rhinoorbital mucormycosis |
| title | Perioperative anesthetic concerns in postcovid mucormycosis patients posted for surgical intervention: An observational Study |
| title_full | Perioperative anesthetic concerns in postcovid mucormycosis patients posted for surgical intervention: An observational Study |
| title_fullStr | Perioperative anesthetic concerns in postcovid mucormycosis patients posted for surgical intervention: An observational Study |
| title_full_unstemmed | Perioperative anesthetic concerns in postcovid mucormycosis patients posted for surgical intervention: An observational Study |
| title_short | Perioperative anesthetic concerns in postcovid mucormycosis patients posted for surgical intervention: An observational Study |
| title_sort | perioperative anesthetic concerns in postcovid mucormycosis patients posted for surgical intervention an observational study |
| topic | anesthetic concerns postcovid rhinoorbital mucormycosis |
| url | http://www.saudija.org/article.asp?issn=1658-354X;year=2022;volume=16;issue=2;spage=176;epage=181;aulast=Misra |
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