Sedation in children is increasingly emerging as a minimally invasive technique that may be associated with local anaesthesia or diagnostic and therapeutic procedures which do not necessarily require general anaesthesia. Standard monitoring requirements are not sufficient to ensure an effective control of pulmonary ventilation and deep sedation. Capnography in pediatric sedation assesses the effect of different drugs on the occurrence of respiratory failure and records early indicators of respiratory impairment. The Bispectral index (BIS) allows the reduction of dose requirements of anaesthetic drugs, the reduction in the time to extubation and eye opening, and the reduction in the time to discharge. In the field of pediatric sedation, capnography should be recommended to prevent respiratory complications, particularly in spontaneous ventilation. The use of the BIS index, however, needs further investigation due to a lack of evidence, especially in infants. In this paper, we will investigate the role of capnography and the BIS index in improving monitoring standards in pediatric sedation. 1. Introduction Sedation in children is increasingly emerging as a minimally invasive technique that may be associated with local anaesthesia or diagnostic and therapeutic procedures, which do not necessarily require general anaesthesia. During pediatric sedation, the problems to be addressed are linked to a higher risk of upper airway obstruction that can lead to hypoventilation and apnoea. In children who are not always able to cooperate, continuous monitoring of spontaneous ventilation and the “depth” of sedation is therefore essential. In pediatric patients under sedation, standard monitoring requirements, including an electrocardiogram, heart rate, noninvasive blood pressure, pulse oximetry, and respiratory rate, are not sufficient to ensure effective control of pulmonary ventilation and deep sedation. In this review, we will investigate the role of the capnography and the BIS index to improve standards of monitoring in pediatric sedation. Moreover, due to an increasing interindividual variability, maintaining the intended level of sedation is often difficult in children; therefore, the use of cerebral monitoring to indicate the depth of anaesthesia could be particularly useful. 2. Capnography Respiratory monitoring should include the assessment of two components: oxygenation and ventilation. The pulse oximetry has become standard monitoring for assessing oxygenation in conscious patients. End-expiratory carbon dioxide (End-tidal CO2) analysis allows assessing of
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