Challenges of Anaesthetic Management in Endoscopic Sinus Surgery in Post COVID Rhino Orbital Cerebral Mucormycosis Patients

Introduction
Mucormycosis is a potentially lethal opportunistic, angioinvasive fungal infection with rapid progression and high mortality and predisposed by diabetes mellitus, corticosteroid other immunosuppressive drugs, haematological malignancies, haematological stem cell transplantation, solid organ transplantation and iron overdose. The aim of our study is to consider the challenge in providing anaesthesia in endoscopic sinus surgery for rhino orbital cerebral mucormycosis in post COVID patient.
Materials and Methods 
A total of 20 patients after being COVID negative, posted for endoscopic debridement of paranasal sinuses and also of orbital contents were analysed with respect to outcome after surgery considering the comorbidities of the patients and toxic effect of antifungal drug. Patients’ comorbidities were optimised through preoperative evaluation prior to surgery. Adequate monitoring of haemodynamic status during intraoperative period and optimum anaesthetic management was provided in endoscopic sinus surgery. The patients were managed in recovery room in post operative period and their outcome was reviewed.
Results
Our patients posed 3 challenges: a) difficult airway in view of palatal perforation b) long standing diabetes mellitus with associated metabolic complications c) administration of amphotericin B could interact with anaesthetic agents and produced adverse outcome. After surgery mortality was experienced in 10% of cases.
Conclusion
Awareness of warning symptoms and signs, a high index of suspicion, early diagnosis and initiation of full dose of liposomal Amphotericin B and meticulous surgical management may help to optimise the outcome of ROCM in the setting of COVID 19 infection.