Purpose of review: The demand of procedures performed on children outside the operating room setting often exceeds the capacity of anesthesia services. The number of children requiring sedation outside the traditional operating room is rapidly approaching the number of children requiring anesthesia in the operating room. We address some of the major issues and controversies in this continuously evolving field.
Recent findings: Pediatric sedation continues to be a challenging field. Recently, the Society of Pediatric Sedation has been created. In the last year, important issues have been raised among pediatric sedation providers, keeping on feeding the debate within all the recognized experts.
Why worry about nihil per os status? Is bispectral index useful as a sedation monitor? Should there be standards for simulation-based training of nonanesthesiologists for delivery of sedation? Is propofol well tolerated? Is dexmedetomidine a good choice for painful procedures? What is the role of etomidate?
Summary: A standard approach (adequate preparation, clinical assessment of the child, fasting as required and right sedation plan) is mandatory to provide safety and efficiency. Sedation is a continuum, and it can be easy to advance from one level to the next and even reach a state of general anesthesia. Newer modalities such as end-tidal CO2 and, maybe, bispectral index monitoring are indeed enhancing the safety of procedural sedation and analgesia.