Procedural sedation is a challenging technique that helps children to tolerate and accept unpleasant procedures. The clinical endpoints are: anxiolysis, drowsiness, analgesia, a certain degree of immobility, minimal depression of cardiorespiratory function and amnesia for the procedure. Spontaneous respiration with a free airway without an adjunct is only guaranteed if accidental loss of consciousness can be avoided (general anesthesia). Therefore the level of sedation must be easily controlled. Due to the great interindividual variability in pharmacokinetics and -dynamics, the effect of a ‘standard’ sedative dose (mg/kg) can vary widely: from minimal sedation to oversedation (general anesthesia). Suppression of the vital functions can lead to hypoxemia, which is the most common reported event. Children should be evaluated prior to the procedure. Titrating the drug to achieve the desired effect and continuous vigilance of the vital functions are crucial for a safe sedation procedure. This paper presents an overview of the preconditions of safe sedation practice in order to enhance its quality.
