Sedation and analgesia for gastrointestinal endoscopy in children

Abstract

Different sedation or anesthesia protocols are available to enable gastrointestinal endoscopic examinations in children. None is optimal. Sedation is organized according to the medical system, resources and the availability of personnel and medication (sedatives, anesthetics, analgesics). If anesthesiologist’s sedation teams for children are not available, strong evidence supports sedation safety and efficiency when it is performed by specially educated non-anesthesiologists and registered nurses. This review is a brief synthesis of main guidelines and position papers of procedural sedation in children and, when unavailable, in adults, who are eligible for pediatric gastrointestinal endoscopy sedation by non-anesthesiologist. Published data are supplemented by clinical experience and the findings of author’s research on ketamine sedation. Other established sedative combinations are benzodiazepine and opioid or propofol as a sole agent or in combination with analgesics. Special stress is given on a proper choice of the sedation protocol for specific examination or procedure in accordance with institution’s policy. Whole endoscopic team has to be engaged in the implementation of new evidence and continuous education to achieve the highest possible safety and quality standards.

Keywords

• deep sedation
• procedures
• endoscopy
• digestive system
• pediatrics