Guidelines for Conscious Sedation of children

Pediatric patients: all patients through 21 years of age, as defined by the AAP.
Must/shall: an imperative need or duty that is essential, indispensable, or mandatory.
Should: the recommended need and/or duty.
May/could: freedom or liberty to follow a suggested or reasonable alternative.
Medical supervision/medical personnel: a currently licensed practitioner of medicine, surgery, or dentistry trained in the administration of medications used for procedural sedation and the management of complications associated with these medications.
Encouraged: a suggested or reasonable action to be taken.
ASA physical status classification: guidelines for classifying the baseline health status according to the ASA (see Appendix 1).
Minimal sedation (formerly anxiolysis): a drug-induced state during which patients respond normally to verbal commands; although cognitive function and coordination may be impaired, ventilatory and cardiovascular functions are unaffected.
Moderate sedation (formerly conscious sedation or sedation/analgesia): a drug-induced depression of consciousness during which patients respond purposefully to verbal commands (eg, "open your eyes," either alone or accompanied by light tactile stimulation, such as a light tap on the shoulder or face, not a sternal rub). For older patients, this level of sedation implies an interactive state; for younger patients, age-appropriate behaviors (eg, crying) occur and are expected. Reflex withdrawal, although a normal response to a painful stimulus, is not considered as the only age-appropriate purposeful response (ie, it must be accompanied by another response, such as pushing away the painful stimulus, to confirm a higher cognitive function). With moderate sedation, no intervention is required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. However, in the case of procedures that may themselves cause airway obstruction (eg, dental or endoscopic), the practitioner must recognize an obstruction and assist the patient in opening the airway. If the patient is not making spontaneous efforts to open their airway to relieve the obstruction, then the patient should be considered to be deeply sedated.
Deep sedation (deep sedation/analgesia): a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully (see discussion of reflex withdrawal above) after repeated verbal or painful stimulation (eg, purposefully pushing away the noxious stimuli). The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained. A state of deep sedation may be accompanied by partial or complete loss of protective airway reflexes.
General anesthesia: a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive-pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired.