Sedation in children – is it time to change our practice?

s, including one [29] in which the incidence and nature of adverse events following 49,836 propofol sedation/anaesthesia encounters was presented. A similar database in the UK, perhaps funded by NHS England and administered by the Association of Paediatric Anaesthetists (APA) or the Royal College of Anaesthetists would be very welcome. Successful sedation in children relies on determining which procedure is appropriate, careful patient selection and preparation, a competent, experienced clinician administering the sedation, appropriate monitoring, and choosing an appropriate sedative drug in the correct dose and route of administration. Intranasal delivery of dexmedetomidine, whether by atomizer or drops is a simple, attractive method of providing reliable sedation. Although not yet routinely used in my hospital, I anticipate a significant increase in its popularity and look forward to even larger trials establishing its efficacy and safety. Acknowledgements CRB is an editor of Anaesthesia and this article was sent out for external review. No other external funding or competing interests declared. C. R. Bailey Evelina London Children’s Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK Email: craig.bailey@gstt.nhs. uk References 1. Sury MR, Arumainathan R, Belhaj AM, Macg Palmer JH, Cook TM, Pandit JJ. The state of UK paediatric anaesthesia: a survey of National Health Service activity. Paediatric Anaesthesia 2015; 25: 1085–92. 2. Nelson TM, Xu Z. Pediatric dental sedation: challenges and opportunities. Journal of Clinical, Cosmetic and Investigational Dentistry 2015; 7: 97–106. 3. Wilson KE, Girdler NM, Welbury RR. A comparison of oral midazolam and nitrous oxide sedation for dental extractions in children. Anaesthesia 2006; 61: 1138–44. 4. Akbulut UE, Cakir M. Efficacy and safety of low dose ketamine and midazolam combination for diagnostic upper gastrointestinal endoscopy in children. Pediatic Gastroenterology, Hepatology and Nutrition 2015; 18: 160–7. 5. Huang A, Tanbonliong T. Oral sedation postdischarge adverse events in pediatric dental patients. Anesthesia Progress 2015; 62: 91–9. 6. Bharti B, Malhi P, Khandelwal N. MRI customized play therapy in children reduces the need for sedation a randomized controlled trial. Indian Journal of Pediatrics 2016; 83: 209–13. 7. Lourenc o-Matharu L, Papineni McIntosh A, Lo JW. Predicting childrens behaviour during dental treatment under oral sedation. European Archives of Paediatric Dentistry 2015; doi:10.1007/s40368-015-0205-9. 8. RCoA training manual: http:// www.rcoa. ac.uk/system/files/TRG-CCTANNEXC_0. pdf (accessed 01/01/2016). 9. Checketts MR, Alladi R, Ferguson K, et al. AAGBI recommendations for standards of monitoring during anaesthesia and recovery 2015. Anaesthesia 2016; 71: 85–93. 10. National Institute for Health and Care Excellence. Sedation in children and young people CG112: 15 December 2010. 11. Morton N. Safe sedation? Anaesthesia 2011; 66: 653–5. 12. Barzegari H, Zohrevandi B, Masoumi K, Forouzan A, Darian AA, Khosravi S. Comparison of oral midazolam and promethazine with oral midazolam alone for sedating children during computed tomography. Emergency 2015; 3: 109–13. 13. Majidinejad S, Taherian K, Esmailian M, Khazaei M, Samaie V. Oral midazolamketamine versus midazolam alone for procedural sedation of children undergoing computed tomography; a randomized clinical trial. Emergency 2015; 2: 64–9. 14. Stephen MC, Mathew J, Varghese AM, Kurien M, Mathew GA. A randomized controlled trial comparing intranasal midazolam and chloral hydrate for procedural sedation in children. Otolaryngology Head and Neck Surgery 2015; 153: 1042–50. 15. Narendra PL, Naphade RW, Nallamilli S, Mohd S. A comparison of intranasal ketamine and intranasal midazolam for pediatric premedication. Anesthesia Essays Research 2015; 9: 213–8. 16. Fallahinejad Ghajari M, Ansari G, Soleymani AA, Shayeghi S, Fotuhi Ardakani F. Comparison of oral and 504 © 2016 The Association of Anaesthetists of Great Britain and Ireland Anaesthesia 2016, 71, 487–505 Editorial