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Equipment available in remote sites should replicate equipment available in the main paediatric facility.

Guidance for paediatric sedation should be developed for the local context by a multidisciplinary team.

Paediatric sedation should be managed in accordance with recognised national guidelines.^41,42

A named anaesthetist should be responsible for liaising with consultants in other departments who have responsibility for sedation, to establish local guidelines and training for the provision of safe sedation by non-anaesthetists.^2,3,89

All institutions where sedation is practised should have a sedation committee. This committee should include key clinical teams using procedural sedation and there should be a nominated clinical lead for sedation. In most institutions, the sedation committee should include an anaesthetist, at least in an advisory capacity.

Each facility should develop written policies, designating the types of operative, diagnostic and therapeutic procedures requiring anaesthesia or sedation.

Guidelines for the management of rare emergencies should be prominently displayed at all sites where sedation is administered.

Mis-selection of high-strength midazolam during conscious sedation is defined as a ‘never event’ by the Department of Health.⁹⁰ Hospitals should report these incidents and any other incidents involving over-sedation to the National Reporting and Learning System.

All patients undergoing procedural sedation should have oxygen saturation monitoring from the administration of sedation to discharge from recovery. Supplemental oxygen should be available and used, as necessary.⁵⁴

Pulse oximetry, ECG, automated non-invasive blood pressure monitoring and wherever there is loss of verbal contact, continuous waveform capnography, should be considered and continued into the recovery period.²²