S[ir]{.smallcaps}---During the SARS‐CoV‐2 (COVID‐19) pandemic, hospitals have canceled elective surgeries and other procedures in children in order to re‐allocate resources and decrease transmission of the COVID‐19 virus.[^1^](#pan13884-bib-0001){ref-type="ref"} However, sedation/anesthetic care for specific subsets of infants and children still needs to be provided. For example, infants or children with oncologic disease need surveillance with lumbar punctures, bone marrow biopsy/aspiration, radiological imaging studies during their treatment, in addition to intrathecal chemotherapy. Children with extremity fractures, new diagnoses of severe headache, back pain, ataxia, stroke symptoms, and septic arthritis, may also require urgent diagnostic (eg, radiological imaging) or therapeutic procedures (eg, fracture reduction/casting, diagnostic joint aspiration).

While some anesthesiologists may advocate for securing the airway of COVID‐19 patients with a cuffed endotracheal tube (ETT) or laryngeal mask airway to eliminate the possibility of aerosol generation during the case; outside of this COVID‐19 pandemic, the vast majority of sedation for many diagnostic or therapeutic procedures are performed outside the operating room using natural airway sedation by pediatric subspecialists including pediatric anesthesiologists, with a high success rate and a very low incidence of adverse events.[^2^](#pan13884-bib-0002){ref-type="ref"} Natural airway sedation performed without airway instrumentation using intravenous agents such as propofol, dexmedetomidine, or ketamine eliminates the need for an ETT or laryngeal mask airway. A systematic review published in 2013 that reported the odds of exposure to the SARS‐Corona virus due to aerosol generation were much lower with suction, administration of oxygen, or manual ventilation compared to airway intubation.[^3^](#pan13884-bib-0003){ref-type="ref"} We therefore suggest that natural airway sedation is an attractive option in some of these patients, and sedation/anesthesia providers should consider the option of natural airway sedation for imaging and other minor procedures rather than general endotracheal anesthesia in order to reduce aerosol particle generation during the COVID‐19 pandemic. Monitoring via nasal cannula with end‐tidal CO2 (EtCO2) detection capacity should still be used and a regular isolation mask applied to over this nasal cannula. Other advantages that associated with this technique in well‐organized sedation programs include shorter duration of sedation, faster recovery, and prompt discharge of the patient which ultimately results in decreased exposure of staff to the patient and lower healthcare cost and resource utilization.[^4^](#pan13884-bib-0004){ref-type="ref"}

Furthermore, we advocate for a telehealth prescreening evaluation and subsequent multi‐disciplinary discussion among the sedation team to ensure optimal patient selection and risk stratification. We suggest the exclusion of high‐risk patients such as those with difficult airways, respiratory distress, copious secretions, American Society of Anesthesiologists‐Physical Status classification \>3, and history of previous anesthesiology consultation. We also urge anesthesia/sedation providers to strictly adhere to guidelines from the Centers for Disease Control (endorsed by ASA, AANA, APSF) on PPE, N95, and other institution dependent infection control measures to decrease transmission of COVID‐19 even if natural airway sedation is performed.[^5^](#pan13884-bib-0005){ref-type="ref"}

CONFLICT OF INTEREST {#pan13884-sec-0002}
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The authors report no conflict of interest.
