Dental Sedation Research Articles

Effect of Dexmedetomidine with or without Midazolam during procedural dental sedation in children: a randomized controlled clinical trial

BackgroundDental anxiety is a global problem in the realm of pediatric dentistry. The use of procedural sedation is recommended to avoid substandard or unsafe dental treatment in preschoolers. This study aimed to compare the effect sedation with Dexmedetomidine with or without Midazolam in terms of sedation level, analgesic effect and ease of treatment completion in preschool children.MethodsA triple blind randomized controlled clinical trial comprised 72 healthy uncooperative children, 4–6 years old, were randomly allocated into three groups of 24 patients each: Group I patients were sedated with nebulized 5 μg/kg Dexmedetomidine (DEX), Group II with nebulized 3 μg/kg DEX followed by nebulized 0.3 mg/kg Midazolam (MID), and Group III with nebulized 0.5 mg/kg MID. Along the session, the three regimens were assessed and compared during the sedation level (children responsiveness) using the Modified Observer’s Assessment of Alertness/Sedation Scale, the analgesic effect using the Face, Leg, Activity, Cry, Consolability scale and ease of treatment completion using a separate 5-point scale. Vital signs were recorded before and during sedation, until full recovery.ResultsA significant difference was detected regarding children responsiveness during operative procedure in favour of DEX in comparison to MID and DEX/MID groups (P = 0.045). Within the DEX group, a significant difference was recorded regarding children responsiveness at optimum sedation and during the operative procedure (P = 0.04). Although, the analgesic effects of sedative drugs showed no statistically significant difference among the study groups (P = 0.20), the ease of treatment completion was statistically higher in the DEX than MID and DEX/MID groups (P = 0.03).ConclusionDexmedetomidine provides a moderate level of sedation, that allowed better patient cooperation, and easy completion of performed dental procedures.

Dental sedation permit requirements for physician anesthesiologists in the United States and the European Union: a review

Purpose of review This review addresses the dental sedation permit requirements for physician anesthesiologists in the United States and the European Union (EU). The regulatory landscape for office-based anesthesia, including dental settings, is often described as the ‘Wild West’ of patient safety, making it crucial to outline the similarities and differences in dental anesthesia regulations and offer practical guidelines for regulators. Recent findings There is virtually no literature that addresses the issue of dental sedation permits for physicians. By summarizing the variation in language and terminology from state to state, this review highlights the inconsistencies and gaps in dental regulations. The review also highlights the limited specific guidance on the permit process for physicians administering dental anesthesia. Summary By comparing dental anesthesia regulations and guidelines across all U.S. states and the EU, the review aims to offer practical guidelines for regulators to institute an oversight process that is fair to physician anesthesiologists and does not impede their ability to practice in the dental office setting. This framework for credentialing and permitting physicians in dental office-based anesthesia settings is informed by existing safety recommendations and best practices.

Dental Sedation and General Anesthesia Considerations for Patients Posthepatic Transplantation.

Hepatic compromise poses significant impacts upon the care of patients undergoing routine dental treatment. When sedation or general anesthesia is planned for dental treatment or oral and maxillofacial surgery, an understanding of basic liver function and clinical evaluation can assist in adapting treatment modifications for patients with limited function due to previous disease and resultant organ transplantation efforts. Beginning with a basic overview of hepatic physiology, this review will outline the specific functions of digestion, metabolism, synthesis, and detoxification involving the liver. Specific clinical considerations will be reviewed regarding comorbidities that develop prior to and after liver transplantation that often impact a patient's suitability for ambulatory and office-based care. Lastly, choices in both local anesthetics, sedative medications, general anesthetics, and postoperative analgesics utilized in dental treatment will be discussed.

Effectiveness of buccal administration of dexmedetomidine and ketamine combination in paediatric dental sedation: A randomized controlled clinical trial.

Pain and anxiety can be considerable obstacles while treating paediatric dental patients. Moderate sedation is needed to treat uncooperative patients. This study aimed to compare the effectiveness of buccal administration of dexmedetomidine-ketamine combination versus dexmedetomidine. Fifty-six uncooperative children were randomly assigned into two groups: Group I received buccal dexmedetomidine (2 μg/kg) and ketamine (2 mg/kg) (DEX-KET), whereas Group II received buccal dexmedetomidine (4 μg/kg) (DEX). The effects of drugs were evaluated based on changes in vital signs, onset and duration of sedation, sedation level, analgesia, ease of treatment and procedural adverse effects. There were no significant differences in vital signs or sedation onset between the two groups. DEX-KET group showed shorter recovery time than DEX group (p < .0001). There were no statistically significant differences between both groups regarding sedation level at optimum sedation and during operative procedure (p = .064, p = .069 respectively). The ease of treatment was significantly better in DEX-KET group than in DEX group (p = .048). Procedural side effects and analgesic effects of the sedative drugs were comparable between both groups. The combination of dexmedetomidine and ketamine delivered buccally provided a better method of delivering care to uncooperative children with more rapid recovery than dexmedetomidine.

Evaluating the Quality of Systematic Reviews on Pediatric Sedation in Dentistry: An Umbrella Review.

Sedation is a depression of a patient's state of consciousness, induced by medications, that can reach different levels of intensity during a medical procedure. Conscious sedation produces a minimally depressed level of consciousness without impairment of the ability to maintain an open airway, of protective reflexes or of responses to verbal and physical stimulation. This umbrella review is aimed at critically assessing the available systematic reviews (SRs) and meta-analyses (MA) on sedation in children/adolescents. An electronic database search was conducted that included Pubmed-Medline, Web of Science, Cochrane, Scopus, Scielo, Embase, LILACS and TRIP and the scope of which extended until January 2023. The risk of bias (RoB) of SRs was analyzed using the Measurement Tool to Assess SRs criteria 2 (AMSTAR2). Of 998 entries, 37 SRs were included. In terms of methodological quality, eight studies were assessed as having critically low quality, four studies had low quality, nine studies had moderate quality, and sixteen were considered to be of high quality. Based on the current guidelines, the most employed drugs in pediatric dentistry for sedation are nitrous oxide and midazolam; however, the available evidence supporting their use is insufficient and of low/critically low quality. The combined technique is recommended (nitrous oxide (30-50%) + midazolam). The optimal dose of oral midazolam is 0.75 mg/kg. The level of methodological quality of SRs is expected to increase according to the results and future directions of this umbrella review.

A Unique Educational Collaboration: Team-Based Learning Modules to Enhance Dental Sedation Safety

A Unique Educational Collaboration: Team-Based Learning Modules to Enhance Dental Sedation Safety

Inhaled methoxyflurane - an explorable alternative to nitrous oxide?

Nitrous oxide is a widely used and well-established form of inhalation sedation in dentistry. Its properties have a wide margin of safety and allow for anxious, paediatric and adult patients to receive dental treatment with minimal impact upon discharge. Nitrous oxide has drawbacks, however, including its environmental impact and need for specialist equipment. Methoxyflurane is another drug which could prove to be an alternative to nitrous oxide. Methoxyflurane's use has proved popular within emergency medicine in Australia and New Zealand for its potent analgesic effects and recognition of its anxiolytic effect. As a result, its use in invasive outpatient procedures has now become popular. Unfortunately, there is very limited evidence of its use within dentistry as a form of inhalation sedation and analgesic. A wider evidence base should be established, as methoxyflurane could prove to be an effective and environmentally friendly alternative to nitrous oxide.

Inhaletion sedation in dentistry - a contemporary method for managing dental anxiety

Inhaletion sedation in dentistry - a contemporary method for managing dental anxiety

A Comparative Study of Parent and Child Perspectives on Using the Intranasal Mucosal Atomization Device for Behavior Management in Pediatric Dental Sedation.

Background Dental anxiety in children often necessitates sedation for effective treatment. Different methods of sedation have proved to be beneficial. However, intranasalsedation provides a needleless, rapid drug delivery method that bypasses hepatic metabolism. Intranasal sedative drugs can be delivered using a mucosal atomization device (MAD). This study aimed to find the opinions, beliefs, and existing knowledge of parents and children regarding intranasal sedation and the method of drug delivery through MAD. Materials and methods The study comprised 50 parents, aged 20 to 50, who came in with a single child, aged five to nineyears. In separate rooms, parents and kids were each shown a video about the use of the intranasal sedation technique with MAD as a pharmaceutical help during routine dental procedures. After the video presentation, each participant was required to complete a pretested self-made questionnaire with 21 questions and multiple-choice options. The chi-square test was used in the statistical analysis of the completed questionnaires (P < 0.05). Paired t-test was used for behavior assessment of the children before and after intranasal sedation. Results A significant correlation between parental socioeconomic status and acceptance of intranasal sedation was observed. Parents with higher education levels exhibited a greater level of acceptance (P = 0.000). Parents whose children had prior dental experiences were more likely to view intranasal sedation as a safe option (P = 0.038). Additionally, a significant proportion of previously sedated children expressed willingness to undergo treatment using intranasal sedation. Evaluation of children's behavior before and after treatment revealed a notable improvement, indicating the effectiveness of intranasal sedation (P = 0.000). Conclusion The study thoroughly investigated how parents and children view intranasal sedation via MAD. It revealed a positive perception of safety and trust among parents regarding this method for pediatric dental procedures.

Impact of dental sedation treatment on the oral health-related quality of life of distressed young children: A secondary analysis of a randomized clinical trial.

Little is known regarding the impact of dental treatment under sedation on distressed young children's oral health-related quality of life (OHRQoL). To evaluate the impact of dental treatment under sedation on the OHRQoL of children and their families. Caregivers of two-to-six-year-old children answered the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS): (1) before treatment under sedation (T0), (2) two weeks (T1) and (3) 3 months after the completion of treatment (T2). A global transition judgment was included in the posttreatment evaluations to determine the perception of changes in OHRQoL after dental treatment. Bivariate analysis was performed. Changes in scores and effect sizes (ES) were calculated. Reductions were found at both posttreatment evaluations in the total B-ECOHIS scores (median [25th-75th percentile] at T0: 14 [9.8-21.7]; T1: 2.0 [0.0-5.1]; T2: 2.0 [0.0-6.7]); "child impact" section (T0: 8.8 [4.0-13.1]; T1: 0.0 [0.0-2.2]; T2: 0.0 [0.0-4.3]) and "family impact" section (T0: 6.0 [4.0-8.5]; T1: 0.0 [0.0-2.0]; T2: 0.0 [0.0-2.0]) (≤0.001; large ES). In 92.3% of cases at T1 and 88.3% at T2, caregivers reported that their child's oral health improved considerably. Dental treatment under sedation significantly improved the OHRQoL of the children and their families.

Dental Sedation with Propofol-based Target Controlled Infusions: Changing Sedation Patterns and Our Current Approach after 2800 Office-based Procedures

We describe the changing patterns of our office-based dental sedation technique over the past 5 years, based on the cumulative experience gained from treating 2800 patients. We also report the changing rate over time of minor, clinically insignificant adverse events based on a recent 652-patient audit of our office-based intravenous sedation (IVS). Our current preference, with most patients, is to administer a combination of propofol via a Target Controlled Infusion (TCI) in combination with TCI remifentanil. The rationale and reasons for this and the progressively changing doses of intravenous (IV) agents are discussed. Our office-based TCI IVS technique affords patient safety, high satisfaction rates and much faster discharge times in comparison with discharge times from mainstream hospitals. The surgeons are provided with greater scheduling flexibility plus the ability to operate in their own office with familiar staff.

Identification of an effective and safe bolus dose and lockout time for patient-controlled sedation (PCS) using dexmedetomidine in dental treatments: a randomized clinical trial.

This study investigated a safe and effective bolus dose and lockout time for patient-controlled sedation (PCS) with dexmedetomidine for dental treatments. The depth of sedation, vital signs, and patient satisfaction were investigated to demonstrate safety. Thirty patients requiring dental scaling were enrolled and randomly divided into three groups based on bolus doses and lockout times: group 1 (low dose group, bolus dose 0.05 µg/kg, 1-minute lockout time), group 2 (middle dose group, 0.1 µg/kg, 1-minute), and group 3 (high dose group, 0.2 µg/kg, 3-minute) (n = 10 each). ECG, pulse, oxygen saturation, blood pressure, end-tidal CO2, respiratory rate, and bispectral index scores (BIS) were measured and recorded. The study was conducted in two stages: the first involved sedation without dental treatment and the second included sedation with dental scaling. Patients were instructed to press the drug demand button every 10 s, and the process of falling asleep and waking up was repeated 1-5 times. In the second stage, during dental scaling, patients were instructed to press the drug demand button. Loss of responsiveness (LOR) was defined as failure to respond to auditory stimuli six times, determining sleep onset. Patient and dentist satisfaction were assessed before and after experimentation. Thirty patients (22 males) participated in the study. Scaling was performed in 29 patients after excluding one who experienced dizziness during the first stage. The average number of drug administrations until first LOR was significantly lower in group 3 (2.8 times) than groups 1 and 2 (8.0 and 6.5 times, respectively). The time taken to reach the LOR showed no difference between groups. During the second stage, the average time required to reach the LOR during scaling was 583.4 seconds. The effect site concentrations (Ce) was significantly lower in group 1 than groups 2 and 3. In the participant survey on PCS, 8/10 in group 3 reported partial memory loss, whereas 17/20 in groups 1 and 2 recalled the procedure fully or partially. PCS with dexmedetomidine can provide a rapid onset of sedation, safe vital sign management, and minimal side effects, thus facilitating smooth dental sedation.

Parental preferences for the procedural sedation of children in dentistry: a discrete choice experiment.

The aim of this study was to explore parental preferences for the procedural sedation of children in dentistry through a discrete choice experiment (DCE) to inform clinical decisions and oral health management. Based on literature reviews, interviews with parents of pediatric dental patients, and expert consultation, six attributes, including fasting time, recovery time, sedative administration routes, adverse reactions, sedation depth and procedure cost, were incorporated into the DCE questionnaire. The DCE questionnaire collected data on parental preferences for pediatric dental sedation treatment from June to August 2022. A conditional logit model was used to analyze preference and willingness to pay (WTP) for each attribute and its level. Subgroup analyses assessing the impact of parents' dental anxiety on procedural sedation preferences were also conducted using conditional logit models. A total of 186 valid questionnaires were gathered. Parents' preferences for fewer adverse reactions, a milder sedation depth, lower out-of-pocket cost, shorter fasting and recovery times and administration by inhalation were significantly associated with their choice of sedation model. The conditional logit model showed that parents were most interested in treatments with no adverse reactions (0% vs. 15%) (Coef, 1.033; 95% CI, 0.833-1.233), followed by those providing minimal sedation (vs. deep sedation) (Coef, 0.609; 95% CI, 0.448-0.769). Moreover, the relative importance of adverse reactions and fasting time was higher among anxious than nonanxious parents. The study found a WTP threshold of ¥1,538 for reducing adverse reactions (15% to 0%). The WTP threshold for the best sedation procedure scenario (no fasting requirement, 10 min recovery time, administration by inhalation, 0% adverse reaction incidence and minimal sedation) was ¥3,830. Reducing the adverse reactions and depth of sedation are predominant considerations for parents regarding procedural sedation in pediatric dentistry, followed by lower cost, shorter fasting and recovery times and inhalation sedation. Parents with dental anxiety had a stronger preference for options with a lower incidence of adverse reactions and shorter fasting time than parents without dental anxiety. This discovery is helpful for doctors and can promote collaborative decision-making among parents and doctors.

Remimazolam Pilot for Office-Based Dental Sedation: Adverse Events, Awareness and Outcomes

In recent years, remimazolam has gained approval for use in adult procedural sedation in both the United Kingdom and the United States, potentially offering an alternative to conventional sedatives like propofol and midazolam for procedural sedation. However, there is a limited body of literature that systematically reviews the outcomes of a remimazolam-alfentanil combination protocol for routine office-based dental procedures. The primary objective of this pilot study was to assess the occurrence of significant adverse events associated with the use of a remimazolam-alfentanil sedation protocol for adult dental procedures. Secondary outcomes included evaluating physiological responses, sedation effectiveness, patient and clinician satisfaction and the incidence of intraprocedural awareness. Notably, no significant adverse events were reported among the 25 adult subjects who received remimazolam and alfentanil, and all dental procedures were successfully completed. Patients and clinicians expressed high levels of satisfaction, and patients did not report any distressing memories associated with the dental procedure. These findings suggest that in a limited cohort, the remimazolam-alfentanil regimen appears to be well tolerated and effective for office-based dental procedures in adult patients, with a low risk of adverse events, acceptable hemodynamic effects, rapid onset and recovery and minimal intraoperative awareness. This study provides valuable insights into the potential use of the remimazolam-alfentanil combination in dental sedation practice.

Oral midazolam vs. intranasal dexmedetomidine plus oral midazolam for sedation of pediatric outpatients: a double-blinded randomized controlled trial

BackgroundModerate to deep sedation is required for dental treatment of children with dental anxiety. Midazolam is the most commonly used sedative, whereas intranasal dexmedetomidine is increasingly used in pediatric sedation.ObjectiveThe aim of this trial was to compare the sedative efficacy of oral midazolam alone with that of intranasal dexmedetomidine plus oral midazolam during dental treatment of children with dental anxiety.DesignIn total, 83 children (aged 3–12 years) scheduled to undergo dental sedation were randomized to receive oral midazolam (0.5 mg/kg) and intranasal placebo, or oral midazolam (0.5 mg/kg) plus intranasal dexmedetomidine (2 µg/kg). The primary outcome was the rate of successful sedation for dental treatment. Secondary outcomes were the onset time and adverse events during and after treatment. Data analyses involved descriptive statistics and nonparametric tests.ResultsThe rate of successful sedation was significantly higher in combination group (P = 0.007), although the sedation onset time was significantly longer in combination group (17.5 ± 2.4 min) than in monotherapy group (15.7 ± 1.8) (P = 0.003). No children required medical intervention or oxygen therapy for hemodynamic disturbances, and the incidences of adverse events had no significant difference between groups (P = 0.660).ConclusionCombined treatment with oral midazolam (0.5 mg/kg) and intranasal dexmedetomidine (2 µg/kg) is more significantly effective for managing the behavior of non-cooperative children during dental treatment, compared to oral midazolam (0.5 mg/kg) alone. (Chinese Clinical Trial Registry: ChiCTR2100042300)Trial registrationChiCTR2100042300, Clinical trial first registration date: 17/01/2021.

A new route to practise sedation independently: integrated conscious sedation training in dental core training

Standards for the provision of and training in dental sedation in the UK are outlined by the Intercollegiate Advisory Committee for Sedation in Dentistry. They detail the necessary curriculum and training that dental practitioners must complete to be able to practise conscious sedation independently. When reviewing the training requirements, it was considered possible to incorporate this into a dental core training scheme where trainees were undertaking sedation as part of their clinical duties. A programme was established to train dental core trainees to undertake independent sedation practice, which was submitted to the local office of Health Education England for validation. This has resulted in a number of dental core trainees becoming certified to independently provide conscious sedation, contributing to their continual professional development.

Evaluating The Knowledge, Awareness and Exposure of Dentists in Conscious Sedation In Relation to Their Current Practice and Future Expectations

Introduction: Conscious sedation in dentistry becoming more popular in Malaysia nowadays. However, the knowledge ,exposure and practice of conscious sedation in dental setting has rarely been explored. Therefore, this study aimed to evaluate the knowledge awareness and exposure of Malaysian dentists about conscious sedation for dentistry and their association with sociodemographic profile. Materials and Methods: A cross-sectional study using an online questionnaire (Qualtrics@ Software) was conducted among Malaysian registered dentists. Questions on sociodemographic profile, knowledge, awareness, exposure and practice on conscious sedation were collected. Chi square test was used to analyse the associated factors for knowledge, exposure and practice. Result: A total of 166 respondents completed the survey, resulting in response rate of 43.1%. Majority agreed that conscious sedation is beneficial in allaying dental anxiety and knows at least 3 types of CS. More than half had been exposed in inhalation sedation (IS) with less than half had CS exposure during undergraduate (UG). However, only a quarter practicing CS in their dental practice. Discussion: Malaysian dentists were familiar with the indications of CS in dentistry which corroborates with other studies. Meanwhile, the exposure to CS during undergraduate study were dependant on the availability and the program structure. Conclusion: Majority of respondents know, but only some are practicing oral and inhalation sedation. Only a few of respondents know about other types of CS. Thus, there is a need for more exposure and training of CS during undergraduate to cater the need of patients with dental anxiety.

Effectiveness and safety of dentist-led conscious sedation using fentanyl with midazolam in dentistry: a five-year retrospective service evaluation.

Background Fentanyl provides systemic analgesia and enhances the sedative effect of benzodiazepines. When midazolam-only sedation is ineffective, fentanyl can be considered as an adjunct, but this advanced sedation technique requires additional training. Studies reporting on the safety and effectiveness of dentist-led conscious sedation using fentanyl and midazolam are lacking.Aims To review the indication of use, safety and effectiveness of fentanyl and midazolam sedation at The Royal London Dental Hospital since its introduction into the service.Method Retrospective data collection of sedation cases from October 2016 to October 2021 was carried out.Results Of the 109 cases included, the majority of patients who had fentanyl (90.8%) had a history of unsuccessful sedation with midazolam. A lower average dose of midazolam was administered when fentanyl was used; the difference was statistically significant (p <0.0001). A higher proportion of patients who had fentanyl and midazolam presented with lower Ellis scores (better operating condition) compared to midazolam-only sedation. No adverse incidents were recorded.Conclusion In this evaluation, the synergistic effects of fentanyl and midazolam resulted in enhanced sedation, anxiolysis and intraoperative conditions. This service evaluation showed some encouraging data regarding the potential safety profile and effectiveness of fentanyl in dental sedation when used by experienced clinicians; however, larger scale studies are required to validate this.

Comparing the Efficacy of 3 and 5 mg/kg Intramuscular Ketamine with the Addition of Oral Midazolam and Atropine in Pediatric Dental Sedation

Statement of the Problem: One of the main obstacles in dealing with pediatric patients is patients’ lack of cooperation when undergoing dental treatment. Providing a safe yet effective method to tackle such a problem is a priority of today’s pediatric dentistry. Purpose: The aim of this study was to compare the sedative effect of 3 and 5 mg/kg intramuscular (IM) ketamine with oral atropine and midazolam. Settings and Design: This clinical trial was performed on 25 uncooperative children aged 3–5 years. Each patient acted as self-control. Patients were randomly divided into two groups. Materials and Methods: In this experimental study, one group received 5 mg/kg ketamine (Daroupakhsh, Iran) IM at first and 3 mg/kg ketamine IM at the second visit, while the other received the same doses in the opposite order. All patients received oral midazolam (0.5 mg/kg) (Dales Pharmaceutical, England) with 0.02 mg/kg atropine (Caspian Co, Rasht, Iran) half an hour before the main IM ketamine injection. Statistical Analysis Used: Collected data were analyzed using ANOVA and Wilcoxon signed-rank test. Results: There was no significant difference between sedative effects of the two administered doses of ketamine (P &lt; 0.1). In the 5 and 3 mg/kg ketamine groups, there were 80% and 76% success rates, respectively. For complications, two cases of emergence reaction and one case of visual disorders were reported in both sessions. Parents were more satisfied with child’s reactions after the 3 mg/kg ketamine dose session. Conclusion: No difference was found in effectiveness between the 3 and 5 mg/kg IM ketamine with the addition of oral midazolam and atropine in the sedation of very young children.

Procedural sedation in dentistry with the use of dexmedetomidine: effects on clinical examples

The presence of acute pain can be the worst negative impressions of a person. Therefore, it is necessary to ensure the control of acute pain for comfort and prevention of the formation of chronic pain syndrome intraoperatively. The development of a multimodal approach to the control of acute pain allows for shorter results. The more we use antinociceptive receptors for pain control, the more comfortable our patient feels. Alpha-2-adrenergic agonists (clonidine, dexmedetomidine) became a key part of the anesthesiologist’s recruitment in the perioperative period. The very selective infusion of dexmedetomidine on alpha-2a central and peripheral receptors and alpha-2c receptors allowed the drug to be more widely absorbed during procedural sedation. The need for more drugs for procedural sedation may be taken to the maximum possible comfort for the patient, the happy doctor and the anesthesiological team, the change in drug administration and the most likely awakening. To balance and satisfy the needs of the consumer to help the most practical way to achieve the goal of combinations of drugs and analysis of useful and negative effects.&#x0D; Special notice. There are presented two cases with typical development but different in terms of surgical applications of clinical manifestations of the described effects, associated with the intake of Kvanadex (dexmedetomidine hydrochloride) during procedural sedation in outpatient dentistry.&#x0D; Conclusions. The administration of dexmedetomidine (Kvanadex) intraoperatively together with propofol during procedural sedation in outpatient dentistry allows to control the pain in the perioperative period with vicarious treatment of basic traditional drugs (acetaminophen, NSAIDs) in non-healing doses, changing the dose of propofol during the procedure, reducing the vomit reflex, allowing for a comfortable follow-up of the doctor’s commands (surgeon, implantologist, orthopedist) and more rapid transfer of the patient to the awakening ward.