Can nasal anesthesia or nasal surgery cause persisting psychiatric symptoms in patients, particularly those with a pre-existing psychiatric condition or history of trauma?

Nasal Anesthesia and Surgery Do Not Cause Persisting Psychiatric Symptoms

Nasal anesthesia and nasal surgery do not cause persisting psychiatric symptoms in patients. The evidence clearly demonstrates that while general anesthesia and surgery can cause transient cognitive changes (delirium, delayed neurocognitive recovery), these are distinct from psychiatric symptoms and typically resolve within days to weeks, not months or years 1, 2.

Understanding the Distinction: Cognitive vs. Psychiatric Disorders

The critical distinction here is between neurocognitive disorders (delirium, cognitive impairment) and psychiatric symptoms (depression, anxiety, psychosis):

• Perioperative neurocognitive disorders encompass cognitive impairment identified in the preoperative or postoperative period, including postoperative delirium and delayed neurocognitive recovery, but these are not psychiatric conditions 1, 2
• Minor short-term depression of mental function is seen after anesthesia and surgery, but general anesthesia does not cause permanent damage or depress mental function beyond the first 2-4 postoperative days 3
• Cognitive changes after anesthesia may persist up to 12 months in some patients, but these represent neurocognitive decline (memory, attention, executive function), not psychiatric symptoms 2

What Actually Happens After Nasal Surgery

Transient Emergence Agitation (Not Persistent Psychiatric Symptoms)

• Emergence agitation occurs in 22.2% of adults undergoing general anesthesia for nasal surgery, but this is an acute, self-limited phenomenon occurring in the immediate postoperative period 4
• Risk factors for emergence agitation include younger age, recent smoking, sevoflurane anesthesia, postoperative pain, presence of a tracheal tube, and presence of a urinary catheter 4
• This agitation resolves rapidly and does not represent a persisting psychiatric condition 4

Pre-existing Psychiatric Conditions Are Amplified, Not Caused

The evidence demonstrates a critical pattern: psychiatric symptoms after nasal surgery reflect pre-existing conditions being amplified by the surgical stress, not new psychiatric disorders caused by the procedure:

• Psychiatric distress (somatization, anxiety, depression) is prevalent in patients presenting for chronic rhinosinusitis surgery, with 31% screening positive for somatization, 17% for anxiety, and 25% for depressive disorders before surgery 5
• Subjects with pre-existing psychiatric distress report more severe symptoms throughout surgical management, but they experience a similar degree of improvement after surgery compared to those without distress 5
• Poor mental health status is associated with poorer self-perception of nasal function before surgery, suggesting that psychiatric symptoms influence symptom reporting rather than being caused by the surgery 6

Empty Nose Syndrome: The Exception That Proves the Rule

• Empty nose syndrome (ENS) patients often present with depression and anxiety, but surgical treatment for ENS actually improves these psychiatric symptoms rather than causing them 7
• The mean scores of both the Beck Depression Inventory II and Beck Anxiety Inventory improved from moderate severity to normal following surgical treatment for ENS (both P < .001) 7
• This demonstrates that when psychiatric symptoms are present in nasal surgery patients, they are either pre-existing or related to the underlying nasal pathology, not caused by the surgery or anesthesia 7

Critical Clinical Caveats

Patients at Higher Risk for Transient Cognitive Changes (Not Psychiatric Symptoms)

Risk factors for perioperative neurocognitive disorders (which are cognitive, not psychiatric) include:

• Advanced age, particularly 70 years and older 2
• Lower premorbid intelligence quotient 2
• Fewer years of education 2
• Pre-existing cognitive impairment (14-48% of patients >70 years already have mild cognitive impairment before surgery) 2

Medications That Can Precipitate Delirium (Not Psychiatric Symptoms)

• Avoid benzodiazepines and anticholinergics in the perioperative period, as these can precipitate delirium 2
• Tricyclic antidepressants and neuroleptic drugs may increase the risk of mental disturbance in patients with pre-existing psychiatric disease or presenile dementia 3
• Effective multimodal pain management is essential, as inadequate pain control can trigger delirium 2

The Bottom Line for Clinical Practice

When patients report persistent psychiatric symptoms after nasal surgery, consider these alternative explanations:

• Pre-existing psychiatric conditions that were present before surgery and are now being attributed to the procedure 5, 6
• Ongoing nasal pathology (such as empty nose syndrome) that is causing secondary psychiatric symptoms 7
• Poor mental health status influencing symptom perception rather than true surgical complications 6
• Perioperative neurocognitive disorders (cognitive changes, not psychiatric symptoms) that typically resolve within weeks to months 1, 2

Psychiatric distress should be considered in patients with persistent symptoms after surgery, but this represents amplification of pre-existing conditions or misattribution, not causation by the anesthesia or surgery itself 5.