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International Journal of Pediatrics
Volume 2010, Article ID 934298, 16 pages
Review Article

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

1Pediatric Sedation Unit, Department of Pediatrics, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
2Dutch Institute for Health Care Improvement CBO, P.O. Box 20064, 3502 LB Utrecht, The Netherlands
3Department of Anesthesiology, University Medical Centre, P.O. Box 85500, 3508 GA Utrecht, The Netherlands

Received 30 December 2009; Accepted 7 May 2010

Academic Editor: Keira Mason

Copyright © 2010 Piet L. J. M. Leroy et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objectives. To investigate which skills and competence are imperative to assure optimal effectiveness and safety of procedural sedation (PS) in children and to analyze the underlying levels of evidence. Study Design and methods. Systematic review of literature published between 1993 and March 2009. Selected papers were classified according to their methodological quality and summarized in evidence-based conclusions. Next, conclusions were used to formulate recommendations. Results. Although the safety profiles vary among PS drugs, the possibility of potentially serious adverse events and the predictability of depth and duration of sedation define the imperative skills and competence necessary for a timely recognition and appropriate management. The level of effectiveness is mainly determined by the ability to apply titratable PS, including deep sedation using short-acting anesthetics for invasive procedures and nitrous oxide for minor painful procedures, and the implementation of non-pharmacological techniques. Conclusions. PS related safety and effectiveness are determined by the circumstances and professional skills rather than by specific pharmacologic characteristics. Evidence based recommendations regarding necessary skills and competence should be used to set up training programs and to define which professionals can and cannot be credentialed for PS in children.