The trauma that characterizes the head area, which is due to several reasons, including the presence of rich innervation and blood vessels in the maxillofacial area and its proximity to the reflexes and the neck area as well. This indicates the removal of tumors within healthy tissues as reconstructive surgery allows the operation to be performed on patients with locally advanced malignancies in the head and neck region, which is often accompanied by serious impairment of upper airway patency by tumor, requiring tracheostomy or fibrotic intubation to provide mechanical ventilation. Analysis of the possibility of an alternative solution to the problem of perioperative analgesia in patients with tumor lesions of the head and neck region led us to study a multimodal scheme of anesthesia, analgesia and sedation based on the highly selective central α 2- adrenoceptor agonist dexmedetomidine, which has sedative, anxiolytic, analgesic and sympatholytic effects. An especially valuable property of dexmedetomidine is the absence of Respiratory depression while maintaining contact with the patient even with deep sedation [1-3]. 

The second component of the scheme, potentiating analgesia, promoting neurovegetative Stability and having an anti-inflammatory effect, is lidocaine administered. A recent British study concluded that general anesthesia, which patients undergo before the operation, is one of the factors responsible for the complications that affect the patient after the operation [4,5].

Surgical anesthesia, which is one of the most important factors in the development of modern surgery, has negative repercussions on brain functions [6].

The authors of the study say that complications resulting from anesthesia may lead to "brain damage", due to the lack of oxygen that reaches it during the surgery period [7,8].

A strong relationship was reached between oxygen levels and brain functions, concluded that these symptoms have serious repercussions, especially on the elderly Despite the widespread use of anesthesia, specialists do not know how exactly it affects it. Perhaps the reason lies in their lack of knowledge of the mechanism of human consciousness [9,10].

Studies conducted over the past decades have indicated that anesthesia leads to loss of consciousness and the inability of different parts of the brain to interact with each other [11].

Disrupting the exchange of information between different parts of the cerebral cortex leads to a pause in consciousness", but this, in turn, can lead to strange side effects after anesthesia, such as loss of cognitive perception and memory And it became clear to them that Propofol binds to the main protein that neurons use to communicate with each other in the brain and this, says Swinderen, leads to a deterioration in the communication between neurons in the brain, because it disrupts the work of the protein Syntaxes 1-A found in humans and this leads to disruption of The interaction between brain cells becomes slow, at least for a while [12].

Perhaps this discovery is important for treating brain diseases in people, for example, in children whose brains are still developing, or in people with Alzheimer's disease or Parkinson's disease.

However, the mechanism that sometimes causes anesthesia problems for the ng or the elderly is still unknown to scientists and as the scientist believes, who in turn reduces this dilemma to the topic of communication “between the movements of protein molecules in the synapses in humans [13].

Anesthesiologists and resuscitators carefully study the condition of each patient on the eve of the operation and select the anesthesia individually in addition, they try to establish a trusting relationship with the patient at the preparatory stage, answering all questions and dispelling doubts so that the surgery passes without stress [14].

Head and neck cancer patients who undergo surgical resection with free flap reconstruction present a unique case Population; Patients present with pain secondary to surgery as well as postoperative interventions including nasogastric and tracheal tubes. Chronic postoperative opioid use has a personal nature and societal influences and is a major contributor to the current opioid crisis [10]. We recently investigated the effectiveness of our center in the management of postoperative pain in head and neck cancer patients undergoing free flap reconstruction. Historically, our center has treated pain after major head and neck cancer surgery using opiates. However, despite the preponderant [13].

122 patients were collected from a hospital Al-Karkh\General Hospital, Baghdad, Iraq and a questionnaire was conducted for them, as it was analyzed through a retrospective effect and through the statistical analysis program, the value of the standard deviation and the arithmetic mean for the ages of the patients were identified, as the patients' ages were 42±6.2 and a comparison was made before and after MMA where the samples were included To patients who underwent surgeries to the head area and through the questionnaire, the type of effect on patients was identified.

The data collection process included patient extracts in addition to smoking and type of surgery. The time for analgesics and the amount of anesthesia administered to the patient were recorded. In addition, opiate doses were converted to oral morphine equivalents.

Patients can answer questions, follow instructions and breathe without assistance. During mild or moderate anesthesia, the patient's sensation of pain or discomfort is very mild or not felt. If the patient is very uncomfortable, an additional dose of sedatives may be given and mild, moderate sedation is good for procedures that require the patient to respond, or for those procedures in which complications may occur due to deep sedation. Recovery from this type of anesthesia is usually much faster.

Two other factors that can lead to this cognitive imbalance have been pointed out: On the one hand, the age of patients - usually affects those over 70 years old. On the other hand, a previous presence of some symptoms of cognitive declines, such as frequent forgetfulness or confusion.

Due to the uncertainty that still exists about the possible causes and consequences of this delusion, several measures have been tried to prevent this cognitive problem from affecting the elderly. Leaving aside medications such as ondansetron, a frequently used 5HT3 antagonist, it is important to detect the problem early in some children, preoperative anxiety favored the onset of delirium or to avoid clinical conditions such as persistent hypotension, hypercapnia, or hypoxia. The use of general anesthesia only for cases where there is no alternative, as local anesthesia limits the chances of developing dementia, as well as the use of Propofol-based total intravenous anesthesia, which indicates a low induction index after surgery.

The study discussed the amount of opioid use in head surgery and it turned out that there was a lower percentage in terms of opiate use (Table 1, Figure 1). 

Table 1: General Characteristics of Patients

Figure 1: p-value Between Parameters

It was also clear that during the statistical analysis by the SPSS SOFT-25 program and based on the logistic analysis of the samples, it was concluded that the use of MMA was inversely related. With the degree of pain present and complications experienced by more patients after using MMA and also the complications that were significantly associated after the surgery, Therefore, MMA appears to be a feasible method to control pain for head and neck cancer patients after surgery and possibly reduce the adverse side effects associated with Using Opioids Although opioids are an important tool for treating cancer-related pain, they are not the only means in medicine's repertoire. The multidisciplinary method is highly recommended by doctors (Table 2, Figure 2). 

Table 2: Other Characteristics of Patients

Figure 2: Show p-value of Parameter

It may include other medications and other types of non-drug treatments and these medications can often be taken orally, so they are easy to use. Medicines may be in tablet form or maybe readily dissolved in the mouth. However, it can't take the medications by mouth, can also take them intravenously, rectally, or through the skin with a patch (Table 3, Figure 3).

Table 3: Logistic Regression Using Analgesics (mg)

Figure 3: Per for Logistic Regression of Opioid Consumption and POD

Head and neck cancer so patients are at risk of developing chronic opioid use after surgery and previous research showed that 41% of patients continued to use opioids at 3 months. Postoperative after primary surgical removal of oral cavity cancer (Figure 4).

Figure 4: Results After Surgery

Other side effects of strong pain relievers include confusion, drowsiness and drowsiness. The severity of these effects varies from person to person and usually occurs with the first doses. But once a constant amount of the drug is in the body, the side effects usually go away. Hallucinations and behavioral changes are uncommon side effects. Less effective pain relievers may have more side effects (Figure 5).

Figure 5: A Complication for the Patient (Number of the Patient)

In addition, the overuse of narcotic analgesics exacerbates migraines. The attacks become more frequent, even daily. To avoid the development of drug dependence, tolerance and chronic headaches, it is necessary to strictly limit the intake of narcotic analgesics to ten doses per month. In addition, there is more and more evidence that taking small doses of narcotic analgesics reduces the effectiveness of other medications in relieving a migraine attack, which can make it more difficult to stop migraine attacks [4].

It was concluded that the method used in our study is a feasible method and distinguished results were obtained after using it and that the use of narcotic analgesics in anesthesia is limited by strict indications because they are strong substances. Accuracy of dosing allows avoiding side effects, serious accidents and even further complications. Displays in results average narcotic analgesic doses, infusion rates and maintenance doses.

At a time when the headache increases from moderate to severe. Delay in taking the drug can lead to an insufficient effect, when the headache only subsides, but does not completely go away and will soon return, which leads to taking another dose.

1. Ducepp, E. et al. “Canadian cardiovascular society guidelines on perioperative cardiac risk assessment and management for patients who undergo noncardiac surgery.” Canadian Journal of Cardiology, vol. 33, 2017, pp. 17–32.

2. Ducepp, E. et al. “Canadian cardiovascular society guidelines on perioperative cardiac risk assessment and management for patients who undergo noncardiac surgery.” Canadian Journal of Cardiology, vol. 33, no. 1, 2017, pp. 17–32.

3. Karthikeyan, G. et al. “Is a Pre-operative brain natriuretic peptide or n-terminal pro–b-type natriuretic peptide measurement an independent predictor of adverse cardiovascular outcomes within 30 days of noncardiac surgery? A systematic review and meta-analysis of observational studies.” Journal of the American College of Cardiology, vol. 54, no. 17, 2009, pp. 1599–1606.

4. Robson, A. et al. “Pre-treatment clinical assessment in head and neck cancer: United Kingdom national multidisciplinary guidelines.” Journal of Laryngology & Otology, vol. 130, suppl. 2, 2016, pp. S13–S22.

5. Talwar, B. et al. “Nutritional management in head and neck cancer: United Kingdom national multidisciplinary guidelines.” Journal of Laryngology & Otology, vol. 130, suppl. 2, 2016, pp. S32–S40.

6. Aziz, M.F. et al. “Routine clinical practice effectiveness of the glidescope in difficult airway management: an analysis of 2,004 glidescope intubations, complications and failures from two institutions.” Anesthesiology, vol. 114, no. 1, 2011, pp. 34–41.

7. Lewis, S.R. et al. “Video laryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation.” Cochrane Database of Systematic Reviews, no. 11, 2016.

8. Law, J.A. et al. “The difficult airway with recommendations for management—Part 2: The anticipated difficult airway.” Canadian Journal of Anesthesia / Journal Canadien d’Anesthésie, vol. 60, no. 11, 2013, pp. 1119–1138.

9. Patel, A. and S.R. Nouraei. “Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE): A physiological method of increasing apnoea time in patients with difficult airways.” Anaesthesia, vol. 70, no. 3, 2015, pp. 323–329.

10. Coyle, M.J. et al. “Replacing tracheostomy with overnight intubation to manage the airway in head and neck oncology patients: Towards an improved recovery.” British Journal of Oral and Maxillofacial Surgery, vol. 51, no. 6, 2013, pp. 493–496.

11. Abdel-Galil, K. et al. “Optimization of intraoperative hemodynamics: Early experience of its use in major head and neck surgery.” British Journal of Oral and Maxillofacial Surgery, vol. 48, no. 3, 2010, pp. 189–191.

12. Cook, T.M. et al. “Equal and opposite expert opinion: airway obstruction caused by a retrosternal thyroid mass management and prospective international expert opinion.” Anaesthesia, vol. 66, no. 9, 2011, pp. 828–836.

13. Gustafsson, I.M. et al. “Apnoeic oxygenation in adults under general anesthesia using transnasal humidified rapid-insufflation ventilatory exchange (THRIVE): A physiological study.” British Journal of Anaesthesia, vol. 118, no. 4, 2017, pp. 610–617.

14. Stephens, M. et al. “Management of elective laryngectomy.” BJA Education, 2017.