Professional Skills and Competence for Safe and Effective Procedural Sedation in Children: Recommendations Based on a Systematic Review of the Literature

Table 1

Overall conclusions regarding the relation between professional competence/skills and PS-related safety.

Nr	Conclusion	Quality level
(1)	Serious PS related adverse events occur more frequently
	(I) In children with an underlying disease.	Level 1
	(A1) Green et al. 2009 [30]
	(B)    Sanborn et al. 2005 [27], Cravero et al. 2009 [26]
	(C)    Malviya et al. 1997 [28], Vespasiano et al. 2007 [29]
	(II) If multiple sedatives are used	Level 1
	(A1) Green et al. 2009 [30]
	(B)    Hoffman et al. 2002 [13], Pitetti et al. 2003 [32], Sanborn et al. 2005 [27], Cravero et al. 2009 [26]
	(C)    Gall et al. 2001 [31]
	(III) In young children	Level 1
	(A1) Green et al. 2009 (<2 years) [30]
	(B)    Cravero et al. 2009 (<6 months) [26]
	(C)    Malviya et al. 1997 (<1 year) [28], Gall et al. 2001 (<1 year) [31]
	(IV) In certain drugs compared to others:
	(IV.1) The combination of a benzodiazepine with an opiate (e.g., midazolam + fentanyl) is associated with a	Level 2
	higher risk of respiratory complications (21–23%) compared to the use of midazolam alone or ketamine
	with midazolam.
	(A2) Yildizdas et al. 2004 [8]
	(B)    Pitetti et al. 2003 [32], Roback et al. 2005 [33], Newman et al. 2003 [34]
	(IV.2) Oral pentobarbital is associated with less adverse events compared to oral chloral hydrate	Level 3
	(B)   Mason et al. 2004 [35]
	(IV.3) In comparison with ketamine, midazolam and ketamine + midazolam, midazolam + fentanyl and	Level 2
	propofol generate a higher risk of hypoventilation and  desaturation.
	(A2)  Yildizdas et al. 2004 [8]
(2)	Serious PS-related adverse events occur less frequently if specifically trained professionals working in dedicated	Level 2
	teams perform sedation according to international guidelines.
	(B) Barbi et al. 2003 [12], Hoffman et al. 2002 [13], Cravero et al. 2009 [26]
	(C) Vespasiano et al. 2007 [29]