**5. References**


In regard to women who are breastfeeding and want sedation for endoscopic procedures, data are limited. It is recommended that patients who received Midazolam should not breastfeed for at least 4 hours after its administration. Breastfeeding restriction time after propofol administration is not well documented, although it is likely to be higher because the maximum concentration in breast milk occurs in 4 to 5 hours after administration. Hence, it is indicated to collect breast milk in a container and subsequently throw it a few hours before resuming breastfeeding. Fentanyl administration is not considered a

Sedation practices are extremely varied, having individual particularities throughout different regions of the world. Cultural, religious, ethical and procedural aspects come into play, dictating the use of a particular type of sedation, exclusion of different classes of agents, or even banning sedation altogether. Even though no or minimum sedation do provide higher safety and shorter follow-up periods, there is an increased tendency, especially in Western patients, to expect some level of sedation. As well as different levels of sedation, different levels of qualification of the individual providing the sedation are expected, depending on the location and the type of the medical unit and the complexity of

In current practice, a various number of sedative agents are used, each with their respective indications and strengths, balanced by a series of unwelcome side-effects and inerrant shortcomings. Particularities such as age, gender, associated conditions, even weight and height, should be taken into consideration when choosing a particular type of sedation level or determining the use of a specific agent. Pediatric gastrointestinal endoscopies present particularities when considering sedation, given the distinctive morphological features of the young, developing body. Particular conditions, such as pregnancy or lactation, should come into play as well, restricting the use of particular agents with proven or suspected

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**4. Conclusion** 

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**4** 

*India* 

**Sedation for Pediatric Endoscopies** 

*1Apollo Centre for Advanced Pediatrics, Indraprastha Apollo Hospital, New Delhi 2The INCLEN (International Clinical Epidemiology Network) Trust International* 

Endoscopy can be a very traumatic event for a child and it is essential that the procedure be smooth, painless and anxiety-free. Hence, endoscopy in children normally requires the simultaneous administration of sedation to warrant the patient's well-being, comfort, and cooperation throughout the procedure. The endoscopist has to balance the benefits with the possible adverse events because sedation related complications are reported to be much more than procedure related events like perforation and bleeding (Thakkar, Elserag et al. 2007). Although there is little agreement amongst pediatric endoscopists on best sedation practices everyone does agree that ensuring the child's safety is paramount (Lightdale,

The goal is always to optimize patient safety and minimize complications. The goals of sedation can be divided into two main categories. These are patient specific and physician/ endoscopist specific. The patient specific goals are anxiolysis, analgesia and amnesia for the procedure. From an endoscopists' perspective, the goals of sedation are cooperation from

Patient assessment and risk stratification is the most important initial step in planning for endoscopy in a child. This should be done at two stages. The first time is when the decision to perform an endoscopy has been made (i.e. in the outpatient clinic etc.) and once just before commencing the procedure. It is just like doing a pre-anesthetic check-up before any surgery.

The ASA classification is used to identify at risk patients and plan sedation accordingly (Table. 1). This classification system although in vogue for nearly 5 decades does not specifically address issues related to children. Healthy neonates and infants do not tolerate similar anesthetics well in comparison to older children and young adults. For these reasons, in further discussions, sedation for endoscopy infants and neonates has been taken up

the patient, completion of the procedure, and no complications.

**3. Patient assessment and risk stratification** 

**4. ASA classification for pre anesthetic status** 

**1. Introduction** 

Mahoney et al. 2007).

**2. Goals** 

separately.

Vidyut Bhatia1 and Narendra Kumar Arora2

