Comparative evaluation of intranasal midazolam-ketamine, dexmedetomidine-ketamine, midazolam-fentanyl, and dexmedetomidine-fentanyl combinations for procedural sedation and analgesia in pediatric dental patients: a randomized controlled trial

Background@#In order to assess the effectiveness of various analgesio-sedative combinations for pain relief and sedation in pediatric dental patients, a thorough evaluation of clinical studies and patient outcomes is necessary. @*Methods@#A total of 128 healthy, uncooperative pediatric dental patients were randomly allocated to receive one of the four combinations of drugs via the intranasal (IN) route: Group I received midazolam-ketamine (MK), Group II received dexmedetomidine-ketamine (DK), Group III received midazolam-fentanyl (MF), and Group IV received dexmedetomidine-fentanyl (DF) in a parallel-arm study design. The efficacy and safety of the combinations were evaluated using different parameters. @*Results@#The onset of sedation was significantly faster in the DF group than in the DK, MF, and MK groups (P < 0.001). The depth of sedation was significantly higher in the DK and DF groups than in the MK and MF groups (P < 0.01). DK and DF produced significant intra- and postoperative analgesia when compared with combinations of MK and MF. No significant adverse events were observed for any of the combinations. @*Conclusions@#The DK and DF groups showed potential as analgesio-sedatives in view of their anxiolytic and analgesic effects.

A rare case report of eyelid basal cell carcinoma with special emphasis on its unusual presentation and role of radiotherapy as its treatment options

Basal cell carcinoma (BCC) is the most common type of skin cancer in white-skinned individuals but is rare in blacks and Indians. Skin cancers mainly affect sun-exposed areas like the neck and face (88-90%). BCC rarely metastasizes or kills, but is still considered as malignant because it can cause significant destruction and disfigurement by invading surrounding tissues. Here we present a case of BCC appearing in upper eyelid at the eyebrow region which is very rare to cite in literature. The patient was a resident of high altitude with no evidence of local invasion or distant metastasis for which she was treated with radiation therapy. Radiation therapy is a good therapeutic option in patients who are unwilling for surgery and in those requiring extensive surgery. BCC is usually not fatal, but early diagnosis and appropriate treatment promises better functionality and esthetic outcome.