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

Table 4

General recommendations on necessary skills and competence for achieving optimal PS related safety and effectiveness in children.

Nr	Recommendations
(1)	Knowledge of the drug dosing, dosing techniques, indications, contraindications, and requisite precautions of the sedation technique used, acquired through specific training or demonstrable relevant experience.
(2)	Regular personal experience of the applied medication or technique*.
(3)	Applying the form of sedation that is most appropriate for the procedure and the patient. This implicates the ability to guarantee the optimally effective sedation level in a predictable manner. An optimal PS technique should achieve near 100% predictable procedural success and timing, an optimal match between desired and achieved levels of sedation, minimal induction, and recovery times and an optimal patient comfort by minimizing procedural pain, anxiety, and the need for physical immobilization or restraint.
(4)	The ability to perform preprocedural screening and a systematic risk analysis.
(5)	The ability to inform the patient, parents or carers about the sedation technique, the effects, potential side effects, and possible alternatives. The information must be given in time and be appropriate for the comprehension level of the patient and parents/carers.
(6)	The ability to guarantee a child-centered approach within a general policy that favors children before, during and after the procedure.
(7)	The ability to apply, or arrange for complementary nonpharmacological techniques like preparation, distraction, combined cognitive-behavioral interventions, and hypnosis.
(8)	The ability to (a) apply effective local or topical anesthesia, if appropriate, and (b) to recognize and intervene with possible toxicity of local anesthetic agents.
(9)	Organizing the necessary monitoring and rescue facilities during and after the procedure for as long as the consciousness level is lowered.
(10)	The ability to organize a supervised recovery phase and to define the discharge criteria.
(11)	The ability to organize the prompt availability of a resuscitation team or a professional trained in Pediatric Life Support.
(12)	Supervising, registering, assessing and optimizing the quality of the sedation in terms of safety and effectiveness.

^∗It is impossible to derive from literature a more precise definition of “regular personal experience”. The authors believe that regular experience means a minimal of 50 PS sessions per year.