Ruskin et al.1  describe how personal protective equipment used because of COVID-19 impairs the performance of anesthesia clinicians and teams. They detail how reductions in the senses of sight, sound, and touch challenge anesthesia care, but they ignore the important sense of smell. This may be the most diminished sense because the proper fit of N95 and similar face masks is often determined by whether the wearer can smell a test odor.2 

We have recently seen complications related to failure to detect odors. An anesthetic vaporizer leaked liquid agent in an operating room, and the leak was not detected until someone without an N95 mask entered the room. Anesthetic gas, which can be smelled in operating room air, is generally above Occupational Health and Safety Administration (Washington, D.C.) permissible exposure limits.3  This incident led us to consider other possible performance impairments from this often-overlooked sense. These include not detecting alcohol on the breath of a patient, use of methyl methacrylate by a surgeon, or bacterial infection of a wound.

The author declares no competing interests.

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