In paediatric patients, esophagogastroduodenoscopy (EGD) is commonly performed with the use of sedation. The aim of the study was to compare the effectiveness of propofol and midazolam in providing procedural amnesia and controlling behaviour in children undergoing diagnostic EGD. Children (9-16 years), classified to the first or second class of the American Society of Anaesthesiologists' physical status classification referred for EGD, were randomly assigned to receive propofol with alfentanyl or midazolam with alfentanyl for sedation during the procedure. Within 120 min after the procedure, patients were repeatedly investigated for memory of the procedure and for memory of pain intensity during EGD with the use of the visual analogue scale. Activity and cooperation of the patient during the procedure was assessed with the relative adequacy scale. Of the 51 children, 48 completed the study. Propofol was significantly better than midazolam in inducing amnesia of procedural pain (mean difference 11.53 mm; 95 % confidence interval [CI] 0.96 to 22.10), loss of memory of the procedure (relative risk 0.4; 95 % CI 0.21 to 0.59) and controlling behaviour (relative risk 2.12; 95 % CI 1.33 to 3.36).

In children sedated for EGD, propofol is significantly better than midazolam at providing procedural amnesia and controlling behaviour during the procedure.

To present evidence and formulate recommendations for sedation in pediatric gastrointestinal (GI) endoscopy by non-anesthesiologists.

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.

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.

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.

Sedation practices for pediatric gastrointestinal endoscopic procedures (PGEP) vary based on infrastructure, availability of trained personnel, and local protocols. Data on prevalent sedation practices is lacking from India. This study aimed to survey the sedation practices for PGEP in India.

A mailing list was constituted with the e-mail addresses of the members of the Indian Society of Pediatric Gastroenterology, Hepatology and Nutrition, Indian Academy of Pediatrics, Association of Surgeons of India, Indian Association of Pediatric Surgeons, and Indian Society of Gastroenterology. The web-based survey was sent by e-mail.

Of the 498 recipients, who responded through the survey link, 91 did not complete the survey. Among those who completed the survey, 91 performed PGEP. Among these 91, 12.1 % performed PGEP without sedation or general anesthesia. Anesthetist involvement was associated with use of propofol based-sedation. Of the respondents, 70.3 % found non-anesthetist administered propofol sedation unacceptable while 38.5 % of the centers had a policy against it. Two-thirds of the respondents were assisted by an anesthetist for most PGEP. An operating room (OR) was used for PGEPs by 23.1 %. PGEP in a non-teaching hospital, non-availability of pediatrician in the endoscopy room, use of an OR for PGEP, and the easy availability of an anesthetist were strongly associated with the involvement of an anesthetist.

The survey indicates a high frequency of involvement of anesthetists and use of OR. This survey should serve as an impetus to evaluate the cost of PGEP in India and the training accorded to non-anesthetists for procedural sedation.

It is more difficult to achieve cooperation when conducting endoscopy in pediatric patients than adults. As a result, the sedation for a comfortable procedure is more important in pediatric patients. The sedation, however, often involves risks and side effects, and their prediction and prevention should be sought in advance. Physicians should familiarize themselves to the relevant guidelines in order to make appropriate decisions and actions regarding the preparation of the sedation, patient monitoring during endoscopy, patient recovery, and hospital discharge. Furthermore, they have to understand the characteristics of the pediatric patients and different types of endoscopy. The purpose of this article is to discuss the details of sedation in pediatric endoscopy.