title: Review on sedation for gastrointestinal tract endoscopy in children by non-anesthesiologists.
abstract: OBJECTIVE
  To present evidence and formulate recommendations for sedation in pediatric gastrointestinal (GI) endoscopy by non-anesthesiologists.
  
  
  METHODS
  The databases MEDLINE, Cochrane and EMBASE were searched for the following keywords "endoscopy, GI", "endoscopy, digestive system" AND "sedation", "conscious sedation", "moderate sedation", "deep sedation" and "hypnotics and sedatives" for publications in English restricted to the pediatric age. We searched additional information published between January 2011 and January 2014. Searches for (upper) GI endoscopy sedation in pediatrics and sedation guidelines by non-anesthesiologists for the adult population were performed.
  
  
  RESULTS
  From the available studies three sedation protocols are highlighted. Propofol, which seems to offer the best balance between efficacy and safety is rarely used by non-anesthesiologists mainly because of legal restrictions. Ketamine and a combination of a benzodiazepine and an opioid are more frequently used. Data regarding other sedatives, anesthetics and adjuvant medications used for pediatric GI endoscopy are also presented.
  
  
  CONCLUSIONS
  General anesthesia by a multidisciplinary team led by an anesthesiologist is preferred. The creation of sedation teams led by non-anesthesiologists and a careful selection of anesthetic drugs may offer an alternative, but should be in line with national legislation and institutional regulations.
authors.affiliation: Rok Orel, Jernej Brecelj, Children's Hospital, University Medical Centre Ljubljana, and Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia.
authors.forename: Rok
authors.initials: R
authors.lastname: Orel
authors.affiliation: Rok Orel, Jernej Brecelj, Children's Hospital, University Medical Centre Ljubljana, and Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia.
authors.forename: Jernej
authors.initials: J
authors.lastname: Brecelj
authors.affiliation: Rok Orel, Jernej Brecelj, Children's Hospital, University Medical Centre Ljubljana, and Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia.
authors.forename: Jorge Amil
authors.initials: JA
authors.lastname: Dias
authors.affiliation: Rok Orel, Jernej Brecelj, Children's Hospital, University Medical Centre Ljubljana, and Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia.
authors.forename: Claudio
authors.initials: C
authors.lastname: Romano
authors.affiliation: Rok Orel, Jernej Brecelj, Children's Hospital, University Medical Centre Ljubljana, and Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Barros
authors.affiliation: Rok Orel, Jernej Brecelj, Children's Hospital, University Medical Centre Ljubljana, and Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia.
authors.forename: Mike
authors.initials: M
authors.lastname: Thomson
authors.affiliation: Rok Orel, Jernej Brecelj, Children's Hospital, University Medical Centre Ljubljana, and Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia.
authors.forename: Yvan
authors.initials: Y
authors.lastname: Vandenplas
keywords: Analgesics; Anesthetics; Colonoscopy; Gastro-intestinal endoscopy; Gastroscopy; Pediatric ages; Sedatives