Effect of anaesthetic agents on olfactory threshold and identification - A single blinded randomised controlled study

Balachandar Saravanan, Pankaj Kundra, Sandeep Kumar Mishra, Gopalakrishnan Surianarayanan, Pradipta Kumar Parida, Balachandar Saravanan, Pankaj Kundra, Sandeep Kumar Mishra, Gopalakrishnan Surianarayanan, Pradipta Kumar Parida

Abstract

Background and aims: Anaesthetics are implicated in cognitive dysfunction, taste and odour deficits in the postoperative period. We aimed to assess the effect of isoflurane, sevoflurane, propofol and regional anaesthesia on the olfactory threshold, olfactory identification and endocrine regulation of associative memory in the postoperative period.

Methods: In this observer-blinded randomised controlled study, 164 patients (>50 years) with the American Society of Anesthesiologists I and II status were randomised into one of four groups to receive regional anaesthesia, general anaesthesia with sevoflurane, general anaesthesia with isoflurane and total intravenous anaesthesia with propofol. Hindi Mental State Examination, olfactory threshold and olfactory identification were tested at 12 h preoperatively (T0), at 3 h postoperatively (T1) and at the time of discharge or postoperative day 3 (T2). In addition, serum melatonin levels were estimated at T0 and T1. The olfactory threshold was tested with n-butyl alcohol and olfactory identification with the University of Pennsylvania Smell Identification Test (UPSIT). Data were analysed using the one-way analysis of variance, Kruskal-Wallis or Mann-whitney tests.

Results: The olfactory identification scores were lower with patients receiving sevoflurane-based anaesthesia at 3 h postoperatively (T1) when compared to preoperative (T0) (median 19.5 vs. 22; P = 0.01). This was accompanied by a significant postoperative reduction of plasma melatonin levels in sevoflurane group when compared to other groups (17.34 ± 4.8 pg/ml vs 23.2 ± 3.5 pg/ml; P < 0.001).

Conclusion: Sevoflurane was associated with short-term olfactory identification impairment with a concomitant reduction in melatonin levels illustrating a possible humoral mechanism.

Keywords: General anaesthesia; neurotoxicity; olfaction; olfactory identification; sevoflurane.

Conflict of interest statement

There are no conflicts of interest.

Figures

Chart 1
Chart 1
Consort flow chart. Group ISO = isoflurane; Group SEVO = sevoflurane; Group TIVA = propofol; Group RA - regional
Figure 1
Figure 1
Box and Whisker plots illustrating the University of Pennsylvania Smell Identification Score (UPSIT) in the four groups of anaesthesia at time points T0, T1 and T2. Group ISO = isoflurane; Group SEVO = sevoflurane; Group TIVA = propofol; Group RA = regional. UPSIT = University of Pennsylvania Smell Identification Test. Represents outliers more than 1.5 times the interquartile range. *P = 0.01: Significantly reduced UPSIT score within the group SEVO among the three time points. **P = 0.006: Significantly reduced UPSIT score in group SEVO at T1 when compared to other groups
Figure 2
Figure 2
Bar chart showing melatonin serum levels in the four groups of anaesthesia at time points T0 and T1. Group ISO = isoflurane; Group SEVO = sevoflurane; Group TIVA = propofol; Group RA = regional. *P < 0.001: Significantly reduced serum melatonin level in group SEVO at T1 when compared to other groups

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