The acute anesthesia-derived decays of the sense of smell in spine surgery.

What is it about?

Thousands of spine patients worldwide are daily subjected to a controlled and reversible loss of consciousness with drugs administered by intravenous infusion or inhalation. General anesthesia is advantageous for the surgeon who operates a motionless body, for the anesthesiologist who has full control of the patient's intrinsic physiological mechanisms, and for the patient who has no pain or future reminiscence (from the Greek anaisthisía: α, ν- “without” and -αí, σθησις “sensation”). However, some reports suggest that the patient may experience another shortage: a reduction of the sense of smell. Postoperative smell disorders were observed in different surgical populations, and they have been studied in relation to drugs used for general anesthesia, such as inhaled Desflurane and Sevoflurane or intravenous anesthetics (TIVA). The anesthetic-induced unconsciousness is known to derive from a general disconnection of higher-order brain centers, with connectivity networks being required for olfactory processing. Inhaled halogenates can nevertheless be the ones mostly affecting the sense of smell because they also collide with the posterodorsal olfactory epithelium of the nasal cavity that houses the odorant receptors (cranial nerve I). Importantly, these sensory neurons play a fundamental role in driving eating behaviors, and subjects with sniffing impairment can decide to alter their diet to compensate for the loss. In fact, the smell of palatable food aromas promotes appetite, liking, and food intake, especially in restrained eaters.

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Photo by Ibrahim Boran on Unsplash

Photo by Ibrahim Boran on Unsplash

Why is it important?

Fasting patients undergoing surgery refrain from eating from the day before, making early oral food after surgery one of the cornerstones of the perioperative nutritional support program in spine surgery. Whether the potential sniffing impairment after surgery could affect the refeeding in surgical patients has never been properly explored, with spine patients being scarcely included in past trials on acute anesthesia-derived decays of the sense of smell.

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