Surgery

Gastrointestinal endoscopic procedures in children cause fear, pain and distress. Deep sedation or general anaesthesia is most likely required to overcome these inconvenience, and to provide high quality procedures for endoscopists as well as a maximum safe environment for children. However, providing deep sedation for these procedures may be challenging due to the comorbid conditions of the child, gastrointestinal pathology requiring endoscopy, and potentially sedation- or anaesthesia related adverse respiratory events. In addition, the anatomical considerations of gastrointestinal tract interfering with both the respiratory abilities and the small caliber of the pediatric airway may become an issue while performing endoscopy in children. Anesthesiologists have been traditionally assigned to provide general anaesthesia or deep sedation in children at risk for developing adverse events. Careful pre-procedural assessment, identification of children potentially at risk for sedation or anaesthesia-related complications, vigilant monitoring during and after the procedure are some of the key elements of a successful sedation strategy. Both cautious selection of anesthetic drug and the dosage administered may also help reducing the adverse events. In addition, safety measurements should always be taken and a careful plan for treating complications should be in place. Moreover, a multidisciplinary approach and communication between anesthesiologists and pediatric gastroenterologists is of utmost important in improving the outcome of children. During the entire sedation process, the predictors of both successful and failed sedation will be discussed.