**4. Post-pediatric gastrointestinal endoscopic period (Recovery and discharge)**

Following sedation it is important that patient monitoring continue until the children are fully awake and ready for discharge. The recovery area should be equipped with oxygen, suction, and equipment for tracheal intubation. Monitoring equipment including non-invasive blood pressure, pulse oximetry, electrocardiography, and ventilation monitoring should be available as well. Patients should be discharged only when they have met specific criteria. The criteria for discharge should include:


Patients who received reversal drugs such as naloxone or flumazenil may require longer periods of observation, because the half-life of the offending agent may exceed that of the reversal medication and lead to resedation. At the time of discharge, specific written and verbal instruction and information as well as the status of the child should be given to a parent, legal guardian or other responsible adult. Specific instructions should be given to the child's family instructing them what to do if the child should appear sedated or have any other medical problems. In the western countries, most of GIE procedures for children can be safely done with ambulatory setting. However, the majority of pediatric GIE procedures in eastern countries like Thailand are done with inpatient setting.

In summary, no method of intravenous sedation can be universally applied to all children requiring gastrointestinal endoscopic procedures. However, in a tertiary care teaching hospital in a developing country, intravenous sedation for pediatric gastrointestinal endoscopic procedures can be safely and effectively performed outside the operating room with a multidrug sedation regimen utilizing anesthesiologists and anesthetic personnel with appropriate basic monitoring.
