Procedural sedation outside the OR — Viva

Viva Stems

1. What is the sedation continuum and why is it clinically important? Cover anxiolysis through general anaesthesia and the risk of inadvertent deep sedation with reactive top-ups.^[2][9]
2. Compare propofol, ketamine and dexmedetomidine for this child, noting that children carry higher sedation risk and that propofol MAC sedation is not label-recommended in children.^{[3][4][7][9][12]}
3. What is the evidence for capnography in procedural sedation? A 13-trial meta-analysis found less desaturation and assisted ventilation; ANZCA recommends continuous waveform capnography where verbal contact is lost.^[10][9]
4. What are the discharge criteria after procedural sedation in the ED? Supervised recovery, practitioner-authorised discharge, responsible-adult escort, written instructions.^[9]
5. How do you manage apnoea after the last propofol bolus? Propofol has no reversal — open the airway, support ventilation, with monitoring and resuscitation equipment already at hand.^[3][9]