Current British guidelines oppose the use of deep sedation by non-anaesthetists.1 2 but all reflect the needs and experience of adult practice. Despite this, and without reference to paediatric opinion, the Royal College of Surgeons of Edinburgh in 1993 stated: “Intravenous sedation is hazardous in children as the therapeutic margin between sedation and anaesthesia is very narrow. In view of this it should be administered only under very special circumstances.”2

At about the same time quite different conclusions were being reached within the paediatric guidelines produced by the American Academy of Pediatrics in 19853 and revised in 1992.4 These guidelines stated: “ …deep sedation in children is an acceptable end point . . .” and that it is “ . . .not mandatory that deep sedation be supervised by an anaesthetist . . .”.

For some time paediatricians have sought the optimal method to reduce the level of consciousness either to allow a procedure to be performed or to avoid the psychological sequelae of a painful or unpleasant procedure. With increasing emphasis on evidence based practice and risk management it was clearly important that this subject was approached with these factors in mind. Stephen Murphy wrote an article for this journal on paediatric sedation in 1997, which focused on the issues of efficacy and safety.5

A highly respected paediatric anaesthetist wrote in September 1995 “Sedating children in order to carry out MRI scans is dangerous and inappropriate and general anaesthesia is the only (safe) choice” (Bray RJ, personal communication, 1995). This article will attempt to determine whether this view can be sustained and will assess the information regarding deep sedation in children undergoing magnetic resonance imaging (MRI) without repeating the arguments put forward in the previous article,5 which are taken as read.