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Nasotracheal intubation is a commonly used technique in elective oral and pharyngeal surgeries. This case report details an incident involving a young adult patient in which an attempt at nasotracheal intubation resulted in a life-threatening cervicofacial and thoracic emphysema. Although complications associated with nasotracheal intubation are rare, their potential severity necessitates a comprehensive preprocedural discussion and risk assessment with the surgical team to confirm its appropriate indication for each individual patient. This case underscores the need for increased awareness and readiness for managing rare but critical complications associated with airway management techniques., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the International Anesthesia Research Society.)

Background: Decline in olfaction may occur after general anesthesia, but the exact incidence and underlying physiopathology remain scarcely investigated. Olfactory dysfunction arises with aging and is known to be linked to cognitive impairment. In this pilot study, we evaluated the incidence of immediate postoperative decline in olfaction and its association with a preoperative cognitive test, performance at Clock Drawing Test (CDT), in a group of older patients., Methods: This pilot study is a sub-analysis of a prospective observational study. Patients ≥ 65 years old and scheduled for elective non-cardiac surgery under sevoflurane-based anesthesia were enrolled. CDT was part of the preoperative evaluation. We assessed olfaction on the day before and the day after surgery (between 16 and 26 h postoperatively) using the Sniffin' Sticks 12-item identification test, which consists of pen-like devices displaying 12 different odors. Postoperative decline in olfaction was defined as a decrease of at least 1 standard deviation in the olfactory score., Results: We included a total of 93 patients, among whom 19 (20.4%) presented a postoperative decline in olfaction. The incidence of postoperative decline in olfaction was higher in the "CDT low-score" (score ≤ 5/8) group (11/34, 32.4%) than in the "CDT high-score" (score ≥ 6/8) group (8/58, 13.6%) (P = 0.030). Despite adjusting for confounding variables, CDT score remained independently associated with immediate postoperative decline in olfactory identification function (OR 0.67, 95% CI 0.48 to 0.94, P = 0.022)., Conclusions: Postoperative decline in olfaction occurred in 20.4% of older patients and was associated with poor preoperative performance at CDT., Trial Registration: This study was retrospectively registered on https://clinicaltrials.gov/ under the NCT04700891 number (principal investigator: Victoria Van Regemorter), in December 2020., (© 2023. BioMed Central Ltd., part of Springer Nature.)