Review on sedation for gastrointestinal tract endoscopy in children by non-anesthesiologists

Table 6 Sedatives and adjuvant medicines for paediatric gastrointestinal endoscopy sedation

Generic name	Mechanism(s) of action	Main undesirable effects	Comments	Ref.
Sedatives
Fentanyl	Opioid receptors agonist; analgesia and sedation	Respiratory depression, hypotension	Due to analgesic effect only it should be combined with benzodiazepine; antagonist naloxone	[38-40]
Ketamine	Binds to the NmethylDaspartate (NMDA) receptors; anesthesia, analgesia, amnesia, sedation, immobilisation	Laryngospasm, hypertension, tachycardia, hypersalivation, vomiting, random movements, increase in intraocular pressure, emergence phenomena (floating sensations, vivid dreams, blurred vision, hallucinations, and delirium)	Beneficial respiratory properties and analgesic potency S(+) isomer has less adverse effects	[40-42]
Meperidine	Opioid receptors agonist; analgesia and sedation	Respiratory depression, pruritus, vomiting	Interaction with monoamine oxidase inhibitors	[38,43,44] [38-40]
Midazolam	GABA receptor agonist; anterograde amnesia, anxiolysis, sedation, hypnosis	Respiratory depression, hypotension, paradoxical agitation	Without analgesic effect; should be combined with analgesic (usually opioids)
			Concomitant use with opioid increases the risk of respiratory depression antagonist flumazenil
Nitrous oxide	Inhalation anaesthetic	Vomiting, dizziness, voice change, euphoria, laughter	The need of scavenging system Use mostly limited to anaesthesiologists	[38,40,45]
Propofol	GABA receptor agonist; sedation, hypnosis, amnesia	Respiratory depression, apnoea, hypotension, painful injection		[38,40,46]
Sevoflurane	Inhalation anaesthetic	Recovery agitation, bradycardia, hypotension, cough, vomiting, seizures	The need of scavenging system Use limited to anaesthesiologists	[47-49]
Antagonists
Flumazenil	Benzodiazepine antagonist	Nausea, vomiting	Contraindicated in benzodiazepine dependence, seizure disorder, cyclic antidepressant overdose, elevated intracranial pressure in patients, and in patients taking medicines known to lower the seizure threshold	[40]
Naloxone	Opioid antagonist	Nausea, vomiting, tachycardia		[40]