Presse Med
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The cognitive dysfunctions observed in patients after anesthesia are due not only to the effects of but also to the surgery, the disease requiring surgery, and post-operative treatment. Initial cognitive recovery from anesthetic agents is usually fast, from several hours to several days, but can be delayed by postoperative treatment (analgesia, for example) that have deleterious cognitive effects. During the initial period after surgery, acute impairment of cognitive functions is seen in some patients at risk (major surgery, aged patients, brain sensitivity, or sepsis), specifically transitory (1-3 days in most cases) postoperative delirium. ⋯ Cognitive dysfunction is still observed at 3 months after surgery in about 10-15% of patients older than 60 years and in about 6% of younger patients. In patients with a pre-existing cerebral disease with cognitive symptoms, the incidence of long-lasting additional cognitive impairment remains unknown. The mechanisms of this long-term cognitive dysfunction remain to be elucidated.
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The frequency of chronic postsurgical pain is high, ranging from 10 to 80%. Among the factors promoting it are the existence of preoperative pain, the intensity and duration of postoperative pain, and the type of surgery. It frequently has a neuropathic aspect. ⋯ Few studies have thus far evaluated methods for preventing chronic postsurgical pain, and their results are conflicting. Recent studies indicate, however, that the use of perioperative regional analgesia is associated with a reduced incidence of chronic postsurgical pain, compared with patient-controlled intravenous morphine. Antihyperalgesic drugs, such as NMDA antagonists, may also decrease chronic postsurgical pain by reducing its perioperative hyperalgesic component.