**6. Method of sedation**

Sedatives should not be administered in a facility unsupervised by medically trained personnel or where appropriate monitoring equipment and manpower are not available, since unrecognized complications may lead to disaster. The method of sedation is determined by the endoscopist and the needs of the patient. Many factors must be considered, including the patient's condition, ASA classification, patients age, the type of procedure (i.e., diagnostic versus therapeutic), the anticipated level of cooperation from the patient, the parents' and patient's preference after being provided these choices and explanation of their risks, as well as the endoscopist's experiences.

There is a wide variation in the method of practice of sedation. Within city of Delhi, India five pediatric gastroenterology setups practice different approaches ranging from no sedation at all to moderate sedation and a mix of deep sedation and general anaesthesia. From other published literature as well, the message is not consistent (Lightdale, Mahoney, et al. 2007). This probably reflects an uncertainty in the optimal method of sedation and the lack of proper guidelines according to the authors. Comfort of pediatric endoscopist for particular types of sedation is equally important.

A conscious sedation protocol is followed at the pediatric gastroenterology division of All India Institute of Medical Sciences, New Delhi, India. For infants below 6 months no sedation is given, while all other children including those under going procedures receive moderate IV sedation.

All children are given the following drugs according to the following protocol prior to endoscopy (Table 2).


\* Lignocaine is added for its cardiac stability

Table 2. Concentration, method of preparation and dosage of drugs used for pediatric sedation at the Pediatric Gastroenterology division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
