We appreciate the interest of Drs Hemelaar and Lemson in our report. We agree that our study supports the utility of pediatric simulators for clinical research and, perhaps, for a role in education and training monitoring skills. We have no disagreement with the notion that more experienced clinicians generally will perform better, at whatever task, than those with less expertise. Furthermore, proper preparation, proper evaluation, and proper recovery should help lead to safe and successful sedation of children.

It is unrealistic to expect and impossible to provide anesthesia-trained personnel for every sedation case. Regardless, it is well understood that even experts may have substandard performance on occasion. Although Hemelaar and Lemson use oximetry only for oxygenation, in our opinion it is a missed opportunity to derive additional value from the device and to exploit the alveolar gas equation for the benefit of their patients. After all, hypoxemia...

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