Editing Anesthesia (section)

== Recovery ==
The immediate time after anesthesia is called [[General anaesthesia#Emergence|emergence]].  Emergence from general anesthesia or sedation requires careful monitoring because there is still a risk of complication.<ref name="AAGBI_Recovery">{{cite journal | vauthors = Whitaker Chair DK, Booth H, Clyburn P, Harrop-Griffiths W, Hosie H, Kilvington B, Macmahon M, Smedley P, Verma R | display-authors = 6 | title = Immediate post-anaesthesia recovery 2013: Association of Anaesthetists of Great Britain and Ireland | journal = Anaesthesia | volume = 68 | issue = 3 | pages = 288–97 | date = March 2013 | pmid = 23384257 | doi = 10.1111/anae.12146 | s2cid = 9519895 }}</ref> [[Nausea]] and vomiting are reported at 9.8% but will vary with the type of anesthetic and procedure.  There is a need for [[airway management|airway support]] in 6.8%, there can be [[urinary retention]] (more common in those over 50 years of age) and [[hypotension]] in 2.7%.  [[Hypothermia]], shivering and confusion are also common in the immediate post-operative period because of the lack of muscle movement (and subsequent lack of heat production) during the procedure.<ref name="Miller 2010" />{{rp|2707}} Furthermore, the rare manifestation in the post-anesthetic period may be the occurrence of functional neurological symptom disorder (FNSD).<ref>[https://www.bjbms.org/ojs/index.php/bjbms/article/view/4646 D'Souza RS, Vogt MN, Rho EH. "Post-operative functional neurological symptom disorder after anesthesia"]. Bosn J of Basic Med Sci. 2020Aug.3;20(3):381–88. {{PMID|32070267}} {{PMCID|7416177}} {{doi|10.17305/bjbms.2020.4646}}</ref>

[[Postoperative cognitive dysfunction]] (also known as ''POCD'' and post-anesthetic confusion) is a disturbance in [[cognition]] after surgery.  It may also be variably used to describe [[emergence delirium]] (immediate post-operative confusion) and early cognitive dysfunction (diminished cognitive function in the first post-operative week).  Although the three entities (delirium, early POCD and long-term POCD) are separate, the presence of delirium post-operatively predicts the presence of early POCD.  There does not appear to be an association between delirium or early POCD and long-term POCD.<ref name="Rudolph2008">{{cite journal | vauthors = Rudolph JL, Marcantonio ER, Culley DJ, Silverstein JH, Rasmussen LS, Crosby GJ, Inouye SK | title = Delirium is associated with early postoperative cognitive dysfunction | journal = Anaesthesia | volume = 63 | issue = 9 | pages = 941–47 | date = September 2008 | pmid = 18547292 | pmc = 2562627 | doi = 10.1111/j.1365-2044.2008.05523.x }}</ref> According to a recent study conducted at the [[David Geffen School of Medicine at UCLA]], the brain navigates its way through a series of activity clusters, or "hubs" on its way back to consciousness. Andrew Hudson, an assistant professor in anesthesiology states, "Recovery from anesthesia is not simply the result of the anesthetic 'wearing off,' but also of the brain finding its way back through a maze of possible activity states to those that allow conscious experience. Put simply, the brain reboots itself."<ref>[https://www.sciencedaily.com/releases/2014/06/140618135834.htm How brain 'reboots' itself to consciousness after anesthesia]. ''Science Daily'' (18 June 2014)</ref>

Long-term POCD is a subtle deterioration in cognitive function, that can last for weeks, months, or longer. Most commonly, relatives of the person report a lack of attention, memory and loss of interest in activities previously dear to the person (such as crosswords). In a similar way, people in the workforce may report an inability to complete tasks at the same speed they could previously.<ref name="Deiner">{{cite journal | vauthors = Deiner S, Silverstein JH | title = Postoperative delirium and cognitive dysfunction | journal = British Journal of Anaesthesia | volume = 103 | issue = Suppl 1 | pages = i41–46 | date = December 2009 | pmid = 20007989 | pmc = 2791855 | doi = 10.1093/bja/aep291 }}</ref> There is good evidence that POCD occurs after cardiac surgery and the major reason for its occurrence is the formation of [[Embolism|microemboli]]. POCD also appears to occur in non-cardiac surgery.  Its causes in non-cardiac surgery are less clear but older age is a risk factor for its occurrence.<ref name="Miller 2010" />{{rp|2805–16}}