Pediatric Dental Patients Research Articles

Reliability of Three Pain Assessment Tools in Children Requiring Dental Treatment: A Comparative Clinical Study

ABSTRACT Background: Accurate pain assessment in pediatric dental patients is crucial for effective pain management and treatment planning. Materials and Methods: A total of 120 children aged 6-12 years, requiring dental treatment, were enrolled in this study. Each child was assessed using the three pain scales after undergoing a standardized dental procedure. The assessments were performed by two independent evaluators to determine inter-rater reliability. The intraclass correlation coefficient (ICC) was used to evaluate the reliability of each tool. Data were analyzed using descriptive statistics and repeated measures ANOVA to compare the mean pain scores across the three scales. Results: The mean pain scores reported were 4.3 ± 1.2 for the VAS, 4.5 ± 1.4 for the FPS-R, and 4.2 ± 1.3 for the WBFPRS. The ICC values for inter-rater reliability were 0.88 for the VAS, 0.86 for the FPS-R, and 0.90 for the WBFPRS, indicating high reliability for all tools. However, the WBFPRS showed slightly higher reliability compared to the other scales. No significant differences were found in pain scores across the three tools (P = 0.72). Conclusion: All three pain assessment tools demonstrated high reliability in assessing pain in pediatric dental patients. The Wong-Baker Faces Pain Rating Scale showed the highest inter-rater reliability, suggesting it may be the most reliable tool for clinical use in this population.

Impact of Dental Treatment Simulation App on Anxiety of Pediatric Dental Patients: An Observational Study

ABSTRACT Aim: The study aimed to investigate the effect of a dental treatment simulation app on the anxiety levels of pediatric dental patients. Materials and Methods: Forty children, aged 4–8 years and with no prior dental experience, were randomly assigned to either the control group (group I) or the dental app group (group II). The children’s anxiety levels were measured before and after undergoing restorative dental treatment, using the Chota Bheem Chutki pictorial scale. Results: The initial anxiety levels were similar across both groups. Post treatment, the dental app group exhibited a significant reduction in anxiety compared to the control group. This suggests that the simulation app has a beneficial effect in lowering dental anxiety in children. Conclusion: The dental treatment simulation app can effectively reduce pre and postoperative anxiety in pediatric patients, potentially enhancing their overall dental experience.

Assessment of Computer-Controlled Starpen Device and Conventional Aspirating Cartridge on Pain Perception in Paediatric Dental Patients – A Split-Mouth Crossover Study

Abstract Background: Local anaesthesia (LA) is the cornerstone for pain management of invasive dental procedures, but the process of delivering it may itself induce anxiety, especially in paediatric patients that can affect the pain perception. Advances such as the computer-controlled LA delivery system have expanded the horizons of LA and can serve as an alternative for painless injections. Objective: To examine the pain perception and anxiety reduction along with patient preference between computer-controlled Starpen device and conventional aspirating cartridge in LA administration for inferior alveolar nerve block. Materials and Methods: The patients were randomly allotted into two groups: Starpen and Septodont syringe where the LA injections were given using both the methods in the 1st week. After a washout period of 1 week, the crossover was performed and the other mode of LA administration was performed in the 2nd week. Pain scores were objectively recorded by the observer using the Face, Legs, Activity, Cry and Consolability (FLACC) scale during LA administration and extraction. Patients were asked to record the pain scores using the Visual Analogue Scale at three phases: (a) mucosa perforation, (b) needle insertion and (c) solution injection. The effect of pain perception on the vital parameters and the preference between the two techniques were assessed. Statistical Package for the Social Sciences (SPSS) version 23.0, Armonk, NY, USA: IBM Corp was used for statistical analysis, and Mann–Whitney U-test and unpaired t-test were utilised to compare the mean difference of two groups at significance level of 0.05. Results and Observations: Intergroup differences among the Starpen and Septodont syringe groups were found to be statistically significant (P < 0.001) during both LA and extraction when pain was objectively assessed using FLACC. Conclusion: Computerised devices such as Starpen offer controlled release of local anaesthetics, effectively decreasing pain perception in paediatric patients and can form a mainstay for the behaviour management of young patients.

Electrosurgical Adjunct for Soft Tissue Management of the Paediatric Dental Trauma Patient

The interface between dental restorations and the neighbouring soft tissue is of key significance for restorative success and longevity. Trauma-related enamel–dentine fractures are frequently present with the restorative challenge of subgingival margins and little remaining tooth structure. This report looks at two paediatric dental trauma patients with extensive crown fractures resulting in subgingival margins, which posed a poor long-term tooth survival. Electrosurgery was used before definitive composite restorations to allow for supragingival margins and access. Each patient attended the Child Dental Health Department at the University of Manchester Dental Hospital for assessment and treatment provision. CPD/Clinical Relevance: This article identifies electrosurgery as an increasingly useful adjunct to restorative management of traumatized permanent incisor teeth in paediatric patients.

Comparative Evaluation of Oral and Intranasal Administration of Midazolam as Preanesthetic Medication in Pediatric Dental Patients Treated under General Anesthesia.

Midazolam is commonly used as a preanesthetic medication for behavior management of children. The current study is conducted to find out the effect of midazolam through nasal and oral routes as a premedicament in pediatric patients treated under general anesthesia. The main aims of the study were: to compare the effect of oral syrup and intranasal spray as preanesthetic medication; to record the undesirable side effects of midazolam by both routes. The patients aged 2-6 years of either sex were randomly divided into two equal groups of 30 each-group I: oral; group II: intranasal. The oral and intranasal routes of midazolam were found to be equally effective and provided adequate sedation for easy separation from the parents and cooperation from children during the induction of anesthesia with minimal side effects. Based on the study results, we can conclude that both oral and intranasal midazolam can be used as preanesthetic medication for pediatric dental patients treated under general anesthesia. In pediatric patients, the oral route should be preferred for midazolam premedication in comparison to the intranasal route. Swati, Shah RK, Tandon S, et al. Comparative Evaluation of Oral and Intranasal Administration of Midazolam as Preanesthetic Medication in Pediatric Dental Patients Treated under General Anesthesia. Int J Clin Pediatr Dent 2024;17(8):881-886.

UPPER LIP FRENECTOMY IN A PEDIATRIC DENTAL PATIENT: Clinical case report of a ten-year-old patient from the city of Mato Verde - MG

Lip brakes have the function of limiting the movement of the lips, stabilizing the midline and inhibiting accentuated gingival exposure. The superior labial frenulum is a fold composed of mucous membrane and fibrous tissue. It is attached on one side to the inside of the upper lips and on the other side to the gums in the middle of the jaw. The objective of this study was to report a case of upper lip frenectomy in a pediatric dentistry patient. This is a study with a qualitative approach with a descriptive/observational objective. A survey was carried out in the municipality of Mato Verde-MG at Faculdade Verde Norte (FAVENORTE). A ten-year-old male patient was taken by the guardian to the dental clinic at Faculdade Verde Norte - FAVENORTE, with the following main complaint: “Large space in the front teeth”. After anamnesis, it was found that the patient had no systemic changes. On clinical examination, the presence of diastema between the permanent upper central incisors and a wide and voluminous upper labial frenulum was observed during the upper laboratory treatment. The treatment was surgical removal: Frenectomy using the Modified Archer Technique. In the case reported, it was demonstrated that the surgical technique was performed successfully, where the repositioning of the labial frenulum and new reinsertion were observed, promoting an improvement in the patient's quality of life.

3D PRINTING: A COMFORTING PROSPECT IN PEDIATRIC DENTISTRY

Three-dimensional (3D) printing is a rapidly developing technology that has gained extensive acceptance and application in dentistry. It is also known as additive manufacturing (AM), rapid prototyping or layered manufacturing. The term 3D printing is generally used to describe a manufacturing approach that builds an object by laying down one layer at a time, adding multiple layers. To meet the needs and requirements for pediatric dental patients, Pediatric dentistry is advancing and shifting towards better to perform dental treatment effectively and efficiently. Among these advancements concept of 3D printing has recently emerged. This article provides an overview of 3d printing: a comforting prospect in pediatric dentistry and its application in pediatric dentistry.

Pattern of pediatric emergency dental care during COVID-19 pandemic in Saudi Arabia

ObjectiveAt the beginning of the COVID-19 pandemic, it was recommended to provide emergency dental care and avoid aerosol-generating procedures (AGPs) when possible. This study aimed to determine how Saudi Arabian pediatric patients utilized emergency dental services at the national level at the beginning of the COVID-19 pandemic and what situations required an AGP. MethodsData was collected from all Ministry of Health dental facilities in Saudi Arabia between March and May 2020. All pediatric dental patients who received emergency dental care during the COVID-19 lockdown were included in this study. ResultsThe majority of the 1,544 pediatric dental patients who received emergency dental care during this period received treatment for caries (77.9 %). AGPs were predominant in the treatment of urgent dental conditions (51.5 %). About 64 % of cases with pulpal inflammation and 52.4 % with abscesses underwent an AGP. ConclusionEmergency and urgent dental conditions were the main reason for seeking dental care during the pandemic (75.8 %), while only 24.2 % of cases were considered non-urgent. Despite the recommendations, AGPs were required for some urgent conditions to relieve the associated pain, and this comprised 46.8 % of dental treatment provided.

Comparative Evaluation of Endo Ice® Refrigerant Spray, Endo Frost® Refrigerant Spray and Topical Anesthetic Agent Precaine B® on the Pain Perception in Children Prior to Administration of Local Anaesthesia – An Invivo Study

To compare and evaluate the efficacy of Endo Ice® refrigerant spray, Endo Frost® refrigerant spray and topical anaesthetic agent Precaine B® on the pain perception during local anaesthesia administration in pediatric dental patients.  Material and methods: A total of 87 participants in the age group of 6-12 years were divided into 3 groups randomly with 29 in each group. The cotton applicator sprayed with Endo Ice was held in contact with the buccal mucosa for 10 seconds. Immediately after the removal of the cotton applicator, inferior alveolar nerve block was administered. Similarly, Endo Frost was used on the participants. 0.1 mg of Precaine B was applied over the injection site contacting the buccal mucosa using sterile cotton applicator. FLACC evaluation was done by one trained personnel during the local anaesthesia administration. Following the local anesthesia, the participants were asked to rate their pain experience using VAS.  Results: The mean score of the Endo ice, Endo frost, and Precaine B were 4.3793, 4.4828 and 5.5517 respectively using the FLACC scale. The mean score of the Endo ice, Endo frost, and Precaine B were 4.2069, 4.2069 and 4.931 respectively using the VAS scale. Greater reduction in pain perception were observed in Endo Ice group followed by Endo Frost group and Precaine group. It was not statistically significant (p<0.005).  Conclusion: Endo ice, Endo frost and Precaine B were effective in reducing the pain perception in children, thereby reducing their fear and anxiety. Endo Ice group showed greater reduction in pain perception and higher efficacy than other groups, even though the results were not statististically significant.

Evaluation of The Role of Music and Bach Flower Remedies in The Management of Anxious Pediatric Dental Patients: A Randomised Clinical Trial

Objective: Dental fear and anxiety describe negative feelings towards the dental environment, particularly significant in pediatric dentistry due to their cognitive, behavioral, and physical impacts on children. Managing this anxiety through positive dentist-child relationships and behavioral guidance techniques is crucial. This study aims to evaluate the effectiveness of passive distraction using music and Bach flower remedy in reducing dental fear and anxiety in children aged 6-8 years. Methods: This randomized controlled clinical study included 12 children (n=4 for each group) aged 6-8 years, randomly assigned to Group 1 (control), Group 2 (Bach flower remedy), or Group 3 (passive distraction with music) for treating superficial dentin caries in primary teeth without local anesthesia. Dental fear and anxiety levels were assessed using objective (heart rate, oxygen saturation, systolic and diastolic blood pressure) and subjective (Facial Image Scale and Venham’s Picture Test) measures before and after treatment. Results: The study included 12 children (6 female, 6 male) with a mean age of 7.3±0.8 years. In Group 2, heart rate significantly decreased after treatment (97.8 ± 10.1 to 90.5 ± 8.8, p.05). Conclusion: In this study, although passive distraction with music and Bach flowers did not have a significant effect on physiological and projective measurement tools in children with dental fear and anxiety, a decrease in heart rate was observed in children exposed to Bach flowers.

Association of Fear and Anxiety Scales in Pediatric Dental Patients Using Brainwave Entrainment: A Randomized Controlled Trial.

Background Dental fear and anxiety are significant issues among pediatric patients, often complicating dental treatments. Various tools measure these emotional responses, including subjective scales such as the Visual Facial Anxiety Scale (VFAS) and Children Fear Scale (CFS), and objective scales such as Venham's Anxiety Scale (VAS) and FranklBehavior Rating Scale (FBRS). This study explores the association between these measures in children subjected to brainwave entrainment (BWE) therapy. This study aimed to evaluate the association between subjective and objective fear and anxiety measures in pediatric dental patients within both the brainwave entrainment (BWE) intervention group and control group. Methods This randomized controlled trial included pediatric participants aged seven to 12 years reporting to the department for dental treatment. Participants were randomized into two following groups: an experimental group receiving BWE therapy and a control group receiving traditional behavioral management. Fear and anxiety levels were measured using subjective and objective scales before and after the intervention. Data were analyzed using Spearman's correlation to examine the associations between these scales, with statistical significance set at p<0.05. Results Post-intervention analysis revealed significant correlations between subjective and objective measures of fear and anxiety in both groups. In the BWE group (N=126), there was a moderate positive correlation between the VFAS and VAS (rho=0.540, p<0.001) and a strong negative correlation between the CFS and FBRS (rho=-0.666, p<0.001).The control group (N=126) showed stronger correlations, rho=0.778 for anxiety scales and rho=-0.817 for fear and behavior scales (p<0.001). Combined data analysis from both groups (N=252) confirmed strong correlations. Conclusion This study found a significant association between subjective and objective measures of fear and anxiety in pediatric dental patients within both the brainwave entrainment (BWE) intervention group and control group. Thereby proving that self-reporting behavioral scales are useful for quickly assessing anxiety in pediatric dental settings.

Comparison of different behaviour management techniques while administering injectable la with minimum pain perception and anxiety in children.

Dental anxiety is a frequent reason for reluctance in young children, leading to challenges in delivering effective dental treatment due to their uncooperative behavior. Aim: The aim of this study was to evaluate and compare the efficacy of different behaviour management techniques while administrating injectable LA with minimum pain perception and anxiety in children. One hundred and twenty children, aged 4 to 10 years, were equally and randomly assigned to four groups. In Group I, local anesthesia was administered while using wireless headphones. For Group II, local anesthesia was administered using a mobile phone with earpieces. Group III received local anesthesia while incorporating the 3D virtual reality eyewear method and Group IV received local anesthesia while utilizing the stress ball technique. Pain and anxiety assessments were conducted using various scales and Physiological parameters such as pulse rate and oxygen saturation levels were recorded and the resultant data were systematically tabulated for subsequent statistical analysis. Virtual reality group showed highly significant result in terms of lowering anxiety and pain scores compared to audio, audio visual, stress ball groups (p<0.001). Virtual group (5.10) also displays significantly highest behavior scores than the audio (1.70), audio visual group (3.96) and Stress Ball groups (2.66). The virtual reality group emerged as the most effective method in alleviating anxiety and pain experienced by pediatric dental patients. Key words:Pain management, Anxiety, Distraction, Virtual reality device, Stress ball, Audiovisual, Audio.

Reducing pain using vibrating device during local anesthesia among Indian pediatric dental patients.

The administration of local anesthesia constitutes one of the most anxiety-inducing and painful stimuli in pediatric dentistry. Therefore, it is of interest to evaluate the effectiveness of vibrating device in comparison to the conventional method for mitigating discomfort while administration of local anesthesia. A total of 30 children aged between 6 and 10 years, requiring local anesthesia for routine dental treatment, were allocated into two groups: a control group and an experimental group, with 15 children in each cohort. In the experimental group, a vibrating device was concurrently placed over the cheek during the administration of the local anesthesia. Pain and discomfort were assessed using both the Wong-Baker FACES Pain Rating Scale (WBFPRS) and the FLACC (Face, Legs, Activity, Cry, CONSOL ability) scale. It was observed that use of the vibrating device was found to be effective in reducing pain and discomfort during the administration of intraoral local anesthesia.

The Effect of Er:YAG Laser Therapy in Combination with Behaviour Management Technique on the Reduction of Anxiety in Paediatric Dental Patients

This study aimed to evaluate the anxiety in paediatric patients during caries treatment, with Er:YAG laser and conventional rotary instruments, in combination with child-management technique Latent inhibition. A group of 126 6–12-year-old children with one or more untreated dentine carious lesions (ICDAS code 05) on the occlusal surface of a primary molar was divided into four equal treatment subgroups. A standardized caries treatment was performed with Erbium:YAG laser or conventional rotary instruments. In the intervention groups, Latent inhibition was used as an anxiety-management technique. During the procedure, objective and subjective stress parameters were recorded. Statistically significant reduction in mean heart rate and self-anxiety scores was seen in the combination of Er:YAG laser caries removal and child-management technique (p &lt; 0.05). The use of laser cavity preparation in combination with the child-management technique Latent inhibition is the most effective method during the dental treatment of children. Er:YAG laser alone showed an advantage over the conventional method and equivalent effect to the combined use of conventional rotary instruments and behaviour management technique.

Evaluating the Effectiveness of CHRIS'S Birds Assisted Therapy on Dental Anxiety among Pediatric Patients: A Pilot Study.

The heart of childhood nurtures an array of immature emotions. Through this rollercoaster of childhood emotions, from tears to laughter, it is the sole responsibility of a pediatric dentist to help the children navigate through their emotions with their empathetic actions. Whenever a child is anxious or fearful in the dental chair, the child may put forth his emotion through crying or taking up a flight response. Dental caries is a disease that is aggravated when a child refuses to cooperate with dental treatment. The tiny holes in the tooth, when unfilled, may lead to bigger problems, which in turn may lead to tooth loss in future. It is the comprehensive responsibility of the pediatric dentist to support health and emotional development and provide a complete, fulfilling oral rehabilitation to the child patient. The purpose of this study was to determine the anxiety levels of pediatric patients visiting the dental Outpatient Department at a Dental College and Hospital in Kavalkinaru. This study unveils a novel technique wherein birds were used in the form of CHRIS'S Birds Assisted Therapy to reduce anxiety in pediatric dental patients. Results showed that intervention with birds through CHRIS'S Birds Assisted Therapy significantly reduced the anxiety levels in children. Thus, CHRIS'S Birds Assisted Therapy is shown to be a promising method of anxiety control, a key to a successful pediatric dental practice. Joybell C, Kumar K. Evaluating the Effectiveness of CHRIS'S Birds Assisted Therapy on Dental Anxiety among Pediatric Patients: A Pilot Study. Int J Clin Pediatr Dent 2024;17(S-1):S84-S94.

Estimation of doses absorbed by the thyroid and salivary glands, eyes, and brains of pediatric dental patients

In addition to the quality of the image, radiological protection of the patient must be considered to ensure an adequate diagnosis in dental radiology, especially in regard to those parts of the patient's body that are close to the radiation beam, such as the thyroid, salivary glands, and brain. In this work, the doses absorbed by the thyroid, salivary glands, eyes and brain of pediatric dental patients undergoing radiographic examinations are estimated using MCNP 6.2 coupled with virtual anthropomorphic phantoms, based on information from dental scenarios with a periapical X-ray unit. The absorbed doses were estimated for five- and 10-year-old male and female children. In the occlusal position, a higher absorbed dose to the thyroid was found for a five-year-old patient, whereas in the molar tube position, the brain was found to receive a higher absorbed dose for five- and 10-year-old patients. The results obtained here, expressed in terms of the absorbed dose, indicate that the beam direction and the use of different image acquisition techniques strongly influence the entrance dose values for the organs of interest in this study.

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.

Effectiveness of brainwave entrainment on pre-operative fear and anxiety in pediatric dental patients: a randomized controlled trial.

The study aims to evaluate the effectiveness of brainwave entrainment on pre-operative fear and anxiety in pediatric dental patients. The study protocol received approval from the Institutional Ethical Committee under reference number 3010/IEC/2021. Pediatric patients (252) aged from 7 to 12years, who reported to the dental department were randomized pre-operatively and presented either with brainwave entrainment (experimental), delivered using a "David delight plus device" or a standard behavior management protocol (control). Baseline and post-assessment of anxiety and fear levels were done using the Visual Facial Anxiety Scale and Frankl's behavior rating scale with Wright's modification. Vitals such as blood pressure and pulse rate were also measured. The study sample (n = 252) comprised 118 females and 134 males. The non-significant differences for values of (VFAS1, FRS1, HR1, and BP1) indicated similar baseline characteristics. In the brainwave entrainment group, the p values of the Mann-Whitney U test and Wilcoxon Signed Ranks test (p < 0.01) between the two-timepoints indicated a statistical difference for the values of (VFAS1, FBRS1, HR1, BP1) and (VFAS2, FBRS2, HR2, BP2). Brainwave entrainment effectively reduces pre-operative fear and anxiety in pediatric dental patients. Therefore, they can be a non-pharmacological and non-invasive behavior management aid. Clinical Trial Registry of India database CTRI/2023/03/051066.

Comparative Study of Different Behavioral Management Techniques in Treating Anxious Pediatric Dental Patients

ABSTRACT Background: Pediatric dental anxiety poses a significant challenge in the delivery of dental care, often resulting in compromised treatment outcomes and negative experiences for both patients and dental professionals. Materials and Methods: A randomized controlled trial (RCT) was conducted involving 120 pediatric dental patients aged 4 to 10 years old, presenting with varying degrees of dental anxiety. Patients were randomly assigned to three groups: Group A received tell-show-do (TSD) technique, Group B received audiovisual distraction (AVD), and Group C received non-pharmacological behavior guidance (NPBG). Anxiety levels were assessed using a standardized anxiety scale before and after the dental procedure. Patient cooperation during treatment, as well as dentist and parent satisfaction, was also evaluated. Results: The study revealed significant reductions in anxiety levels across all groups post-treatment. However, Group B (AVD) demonstrated the most substantial reduction in anxiety scores, with a mean decrease of 60% from baseline. Group A (TSD) and Group C (NPBG) showed comparable reductions in anxiety levels, with mean decreases of 45% and 50%, respectively. Patient cooperation during treatment was highest in Group B, followed by Groups C and A. Dentist and parent satisfaction scores were significantly higher in Group B compared to the other groups. Conclusion: AVD emerged as the most effective behavioral management technique for treating anxious pediatric dental patients, resulting in significant reductions in anxiety levels and higher levels of patient cooperation during treatment compared to TSD and NPBG techniques.

Comparison of intranasal ketamine with intranasal midazolam and dexmedetomidine combination in pediatric dental patients for procedural sedation: A crossover study.

The main goal of the pediatric dentist is to address and reduce children's fear and anxiety during the dental treatment, especially when conventional behavior-guiding strategies fail. In such cases, the use of pharmacological agents becomes an essential factor to consider. The objective of the study was to compare the efficacy, safety, and acceptability of intranasal ketamine (INK) with the combination of intranasal midazolam and dexmedetomidine (INMzD) in pediatric dental patients for the procedural sedation. Forty-seven children aged 3-9 years who required dental procedures such as extractions, pulpectomy, and restorations were randomly distributed into two groups using the envelope drawing method. Group INK received 7 mg/kg INK, whereas Group INMzD received a combination of midazolam spray (0.3 mg/kg) and atomized dexmedetomidine (3 μg/kg). INK showed faster onset, faster recovery, and shorter discharge time than INMzD. Both groups had acceptable physiological parameters and no postoperative complications. INK was more accepted by the patients than INMzD. In terms of efficacy, safety, and acceptability, INK outperformed the combination of INMzD for the procedural sedation.