Guidelines for Complications of Cancer Treatment Vol VIII Part B

Extensive and proactive evaluation and questioning maybe necessary to overcome barriers that hindercommunication regarding unrelieved pain.Anesthesiologists should recognize that geriatric patientsmight respond differently than younger patients to painand analgesic medications, often because of comorbidity.Vigilant dose titration is necessary to ensureadequate treatment while avoiding adverse effects suchas somnolence in this vulnerable group, who are oftentaking other medications (including alternative andcomplementary agents).Other GroupsPatients who are critically ill, cognitively impaired (e.g.,Alzheimer’s disease), or who otherwise have difficultycommunicating (e.g., cultural or language barriers) presentunique challenges to peri-operative pain management.Anesthesiologists should recognize that patients who arecritically ill, cognitively impaired, or havecommunication difficulties may require additionalinterventions to ensure optimal peri-operative painmanagement.Anesthesiologists should consider a therapeutic trial ofan analgesic in patients with elevated blood pressure andheart rate or agitated behavior, when causes other thanpain have been excluded.Management of difficult airwayA large number of these malignancies are related to head andneck region mainly in men due to prevalence of tobaccochewing largely in rural population. Primary malignancy ormetastatic tumors at the region of head neck especiallylaryngeal level, or mediastinum may cause airway obstruction.61