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

Comparative study of the effects of intrathecal clonidine and fentanyl as adjuvant with low dose hyperbaric bupivacaine for unilateral spinal anaesthesia in lower limb surgery

Background and Aims: Unilateral Spinal anaesthesia with bupivacaine is administered for lower limb surgeries. The aim of the study is to compare between the effects of Clonidine and Fentanyl when added as an adjuvant to low dose bupivacaine in unilateral spinal anaesthesia in lower limb surgery on the basis of onset and duration of sensory and motor blockade and post-operative analgesia. Material & Methods: After obtaining the institutional ethics committee approval total 150 patients ofeither sexbetween 18 to 55 years of age, American Society of Anaesthesiology (ASA) I and II scheduled for elective lower limb surgery were divided into three groups. All patients received 0.5% hyperbaric bupivacaine (7.5mg) 1.5ml intrathecally along with ± adjuvant ( In Group A - clonidine (30 microgram) 0.2 ml diluted with normal saline to make 0.5 ml, Group B- fentanyl 25 microgram or 0.5 ml, Group C only 0.5ml normal saline) to make total 2ml solution . The results of observations were tabulated, compiled and statistically analysed using SPSS (version) 25.0 and Graph Pad prism version 5. Result : Fentanyl and clonidine both when added to low dose bupivacaine in unilateral spinal anaesthesia prolonged the duration of sensory and motor block compared to only low dose local anaesthetic agent. The time duration before the use of first dose of rescue analgesic is more prolonged in the group receiving clonidine as compared to Fentanyl group patient