Management of Rhino-Orbital-Cerebral Mucormycosis Infection: Anesthetic Challenges
نویسندگان
1 Department of Pulmonology, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
2 Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran.
3 Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran.
4 Department of Infectious Disease, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
5 Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran.
6 Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran.
7 Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
8 Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran.
9 Department of Molecular Microbiology & Immunology, South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, Texas, USA
doi
10.22034/cmm.2025.345516.1743چکیده
Despite the application of surgery and antifungal therapy, rhino-orbital-cerebral mucormycosis is a severe and life-threatening fungal infection with high morbidity and mortality, particularly in immunocompromised patients. This review focuses on the current evidence on the perioperative anesthetic management of rhino-orbital-cerebral mucormycosis, emphasizing the unique challenges its aggressive, angioinvasive nature poses. Key issues include difficult airway management due to fungal debris and supraglottic edema, hemodynamic instability, renal dysfunction because of nephrotoxic antifungal therapy (e.g., amphotericin B), and the critical need for glycemic control in diabetic patients. Case studies illustrate the complexities of managing comorbidities such as post-COVID-19 sequelae, uncontrolled diabetes, and immunosuppression. Preoperative optimization, judicious fluid and electrolyte management, and the use of video laryngoscopy for difficult intubation are highly recommended. By addressing these challenges, this article provides a practical framework for anesthesiologists to enhance perioperative care in patients with ROCM, ultimately improving survival and reducing complications. Awareness of these procedures may help clinicians choose the most effective treatment regimens. However, further studies are warranted to correlate these findings with clinical outcomes.
