COVID-19 associated Mucormycosis (CAM): Implications for perioperative physicians - A narrative review

Area of Science:

• Medical Mycology
• Infectious Diseases
• Anesthesiology

Background:

• Mucormycosis incidence has dramatically increased during the COVID-19 pandemic, becoming a significant health threat.
• India reported approximately 70% of global cases of COVID-associated mucormycosis (CAM), leading to its declaration as a notifiable disease.
• The second COVID-19 wave saw a sharp rise in mucormycosis, with patients requiring surgical interventions for sequelae.

Purpose of the Study:

• To highlight the challenges in anesthetic management for patients with mucormycosis, especially rhino-orbito-cerebral mucormycosis (ROCM).
• To discuss the contributing factors to the rise of ROCM, including injudicious corticosteroid use in vulnerable populations.
• To outline essential considerations for perioperative care in this patient group.

Main Methods:

• Review of clinical presentations and anesthetic considerations for mucormycosis patients.
• Analysis of factors contributing to increased ROCM incidence during the pandemic.
• Discussion of anesthetic challenges including co-existing conditions and drug interactions.

Main Results:

• Rhino-orbito-cerebral mucormycosis (ROCM), caused by Rhizopus arrhizus, is the most common form.
• Injudicious corticosteroid use is implicated as a major factor in the surge of ROCM.
• Anesthetic concerns include COVID-19, uncontrolled diabetes, potential airway difficulties, and drug interactions.

Conclusions:

• Effective anesthetic management hinges on thorough preoperative assessment and optimization.
• Multidisciplinary collaboration is crucial for successful perioperative care.
• Vigilance and comprehensive management strategies are vital for improving patient outcomes in mucormycosis cases.