**2. Pre-pediatric gastrointestinal endoscopic assessment period**

The general health status of each patient undergoing pediatric procedural intravenous sedation must be evaluated. A physical examination should focus primarily on the upper airway, lungs, cardiovascular system, and baseline neurological status. To aid in assessment risk, the American Society of Anesthesiologists (ASA) has developed a classification system for patients, which categorizes individuals on a general health basis. Several studies have documented the fact that sedation risk in children rises with increasing ASA physical status (Cote et al., 2006; Krauss & Green, 2006; Vespasiano et al., 2007). ASA physical status 1 and 2 are considered low risk patient populations. ASA physical status 3 and 4 are high risk patient populations. The specific high risk patient populations in which anesthesia consultation may be warranted including known respiratory or hemodynamic instability, obstructive sleep apnea, high risk airway management, ASA physical status ≥4, infants born <37 weeks and <60 weeks post conception, history of sedation related adverse events, and patients with neuromuscular disease affecting respiratory or brain stem function.

In this pre-assessment period, there are no differences in a routine practice between the developed countries and the developing countries. Additionally, the majority of intravenous sedation practices for pediatric gastrointestinal endoscopic procedures in the developing countries were sedated by anesthesiologists and/or anesthetic personnel in the operating room.
