Intravenous Sedation for Pediatric Gastrointestinal Endoscopy in a Developing Country

The field of pediatric sedation and analgesia has evolved over the past two decades. The growing number of pediatric gastrointestinal endoscopy procedures requiring sedation and analgesia are recognized even in developing countries. It is well accepted that children undergoing diagnostic and therapeutic gastrointestinal endoscopic procedures should receive sedation and/or anesthesia. Nevertheless, considerable practice variation prevails. The ability to provide safe and effective sedation and analgesia is an important skill for physicians involved in pediatric patients. Children are more prone to anxiety in the acute setting. Procedural sedation and analgesia is the use of sedative, analgesic and dissociate drugs to provide anxiolysis, analgesia, sedation and motor control during painful and unpleasant procedures. Intravenous sedation for pediatric gastrointestinal endoscopic procedure is ubiquitous in any hospital that cares for children and depending on the institution and country. The developing countries have no their practice guidelines. The guidelines established by the American Academy of Pediatrics (AAP) (Cote et al., 2006), the American Society of Anesthesiologists (ASA, 2002) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) serve as the standard for institutional policy development in the area of pediatric intravenous sedation. The guideline defines terms throughout and in particular: Minimal sedation: a drug-induced state which patients respond normally to verbal commands. Moderate sedation (conscious sedation): a drug-induced depression of consciousness which patients respond purposefully to verbal commands. Spontaneous ventilation is adequate. Cardiovascular function is usually maintained. Deep sedation: a drug-induced depression of consciousness which patients can not be easily aroused but respond purposefully after repeated verbal or painful stimulation. Spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained. General anesthesia: a drug-induced loss of consciousness which patients are not arousable, even by painful stimulation. Patients often require assistance in maintaining a patent airway. Cardiovascular function may be impaired.