Maniaci Antonino, Lentini Mario, Trombadore Rosario, Gruppuso Loris, Milardi Santo, Scrofani Rosario, Cuttone Giuseppe, Sorbello Massimiliano, Modica Rodolfo, Lechien Jerome R, Boscolo-Rizzo Paolo, Paternò Daniele Salvatore, La Via Luigi
Deparment of Medicine and Surgery, University of Enna "Kore", 94019 Enna, Italy.
Asp 7 Ragusa, 97100 Ragusa, Italy.
Life (Basel). 2025 Feb 22;15(3):344. doi: 10.3390/life15030344.
Neurological and olfactory disturbances are increasingly recognized as potential complications of general anesthesia, particularly in vulnerable populations, such as the elderly, children, and individuals with comorbidities. Recent studies have highlighted the need for tailored anesthetic approaches in these high-risk groups to mitigate potential long-term effects. These disturbances, including postoperative cognitive dysfunction, delirium, and olfactory deficits, often arise from shared pathophysiological mechanisms, such as neuroinflammation, oxidative stress, and disruptions in cerebral perfusion. The olfactory system is particularly susceptible to anesthesia-induced neurotoxicity given its proximity to central nervous system structures and its role in sensory and cognitive processing. Furthermore, the unique regenerative capacity of olfactory neurons may be compromised by prolonged or repeated exposure to anesthetic agents, potentially leading to long-term olfactory dysfunction. Risk factors, such as advanced age, neurodegenerative diseases, diabetes, cardiovascular conditions, genetic predispositions, and the type and duration of anesthesia exposure, further exacerbate these complications. Preventive strategies, including comprehensive preoperative risk assessment, personalized anesthetic protocols based on genetic and physiological profiles, and proactive postoperative care with early intervention programs, are critical for reducing impairments and improving long-term patient outcomes. Emerging evidence highlights the potential role of neuroprotective agents, such as antioxidants and anti-inflammatory therapies, in mitigating the effects of anesthesia-induced neurotoxicity. Longitudinal studies are needed to evaluate the long-term effects of anesthesia on cognitive and sensory health, particularly in high-risk populations. These studies should incorporate advanced neuroimaging techniques and biomarker analysis to elucidate the underlying mechanisms of anesthesia-induced neurological and olfactory disturbances. This narrative review provides a comprehensive overview of the mechanisms, risk factors, and preventive strategies for neurological and olfactory disturbances after general anesthesia and highlights future directions for research to improve patient outcomes. We conducted a comprehensive literature search using databases, such as PubMed and Scopus, to identify relevant studies.
神经和嗅觉障碍越来越被认为是全身麻醉的潜在并发症，尤其是在老年、儿童和患有合并症等易受影响的人群中。最近的研究强调，在这些高危人群中需要采用量身定制的麻醉方法，以减轻潜在的长期影响。这些障碍，包括术后认知功能障碍、谵妄和嗅觉缺陷，通常源于共同的病理生理机制，如神经炎症、氧化应激和脑灌注紊乱。嗅觉系统因其与中枢神经系统结构接近以及在感觉和认知处理中的作用，特别容易受到麻醉诱导的神经毒性影响。此外，嗅觉神经元独特的再生能力可能会因长期或反复接触麻醉剂而受到损害，从而可能导致长期嗅觉功能障碍。年龄增长、神经退行性疾病、糖尿病、心血管疾病、遗传易感性以及麻醉暴露的类型和持续时间等风险因素会进一步加剧这些并发症。预防策略，包括全面的术前风险评估、基于基因和生理特征的个性化麻醉方案，以及通过早期干预计划进行积极的术后护理，对于减少损伤和改善患者长期预后至关重要。新出现的证据突出了神经保护剂，如抗氧化剂和抗炎疗法，在减轻麻醉诱导的神经毒性影响方面的潜在作用。需要进行纵向研究来评估麻醉对认知和感觉健康的长期影响，尤其是在高危人群中。这些研究应纳入先进的神经成像技术和生物标志物分析，以阐明麻醉诱导的神经和嗅觉障碍的潜在机制。这篇叙述性综述全面概述了全身麻醉后神经和嗅觉障碍的机制、风险因素和预防策略，并突出了改善患者预后的未来研究方向。我们使用PubMed和Scopus等数据库进行了全面的文献检索，以识别相关研究。
