Procedural sedation medicines

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Target exams

Red flags

• Sedating a child for a painful procedure with a benzodiazepine alone and no analgesic, so the child is paralysed by the stimulus but cannot escape the pain
• Giving a midazolam and opioid together without a dedicated observer, then being surprised by apnoea from their synergistic respiratory depression
• Using pulse oximetry alone and missing hypoventilation, because supplemental oxygen masks desaturation until the child is dangerously hypercapnic
• Delaying an urgent painful procedure for a fasting window when the PSA evidence shows fasting does not reduce adverse events in the emergency setting
• Proceeding without an independent sedationist whose only job is the airway, because the proceduralist cannot watch the drug and the wound at once
• Discharging before the child returns to baseline arousal, protects the airway, and can tolerate oral intake

Life stages

Care settings

Clinical exam formats

Board mappings

• General and Community Paediatrics — procedural sedation and analgesia principles and safety
• Acute care — medicines used for procedural sedation in children
• Acute care and emergency paediatrics — selecting and dosing procedural sedation agents
• Patient safety — monitoring, fasting, and rescue during procedural sedation
• Pharmacology of ketamine, nitrous oxide, midazolam, dexmedetomidine and propofol for sedation
• Preprocedural assessment, monitoring including capnography, and discharge criteria
• Short case and structured discussion of a child needing fracture reduction or wound repair under sedation
• Discussion of a sedation adverse event and its prevention
• Patient safety and quality improvement: safe sedation and monitoring
• Pharmacology — sedative and analgesic medicines in children
• Foundation of Practice (FOP) — pharmacology of sedation agents
• Applied Knowledge in Practice (AKP) — procedural sedation safety and adverse events
• Communication scenarios — explaining sedation, fasting and risk to a family
• History taking and management — a child for a painful procedure
• General Pediatrics Content Outline — sedation pharmacology and safety
• Systems-based practice — sedation protocols, monitoring and rescue
• Patient Care — procedural sedation with appropriate monitoring and rescue
• Systems-Based Practice — sedation safety systems and team roles
• Medical Knowledge — pharmacology and adverse effects of sedation agents
• Medical Expert — pharmacology and safe conduct of procedural sedation in children
• Collaborator — sedation team roles and the independent sedationist
• Patient Safety — monitoring, fasting and rescue