Paeds Vivas · investigations-procedures-and-technology
Safe paediatric procedural sedation — branching viva
Branching viva on safe paediatric procedural sedation: the sedation depth continuum, the pre-sedation assessment, fasting and monitoring, the pharmacology of ketamine and nitrous oxide, the management of laryngospasm and oversedation, and the recovery and discharge criteria.
On this page
Study tools
Target exams
RACP DCEMRCPCH ClinicalRCPSC PediatricsABP General Pediatrics
Prompt
Emergency department: a 5-year-old, ASA I, with a displaced forearm fracture needing urgent reduction, last ate three hours ago. The examiner asks how you define and classify procedural sedation, what pre-sedation assessment you perform, how you use the fasting history, which agent and dose you choose — then branches to the child who develops laryngospasm during ketamine sedation, to the role of capnography versus pulse oximetry, and finally to the recovery and discharge criteria.
Opening question
Define procedural sedation and analgesia for me, and walk me through the four levels of the sedation depth continuum. Which boundary matters most for who should be performing the sedation? [2]
References5ShowHide
- [1]Krauss B, Green SM Procedural sedation and analgesia in children Lancet, 2006.PMID 16517277
- [2]Coté CJ, Wilson S Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures Pediatrics, 2019.PMID 31439084
- [3]Green SM, Roback MG, Kennedy RM, et al Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update Annals of Emergency Medicine, 2011.PMID 21256625
- [4]Langhan ML, Shabanova V, Li FY, et al A randomized controlled trial of capnography during sedation in a pediatric emergency setting American Journal of Emergency Medicine, 2015.PMID 25445871
- [5]Green SM, Krauss B Pulmonary aspiration risk during emergency department procedural sedation--an examination of the role of fasting and sedation depth Academic Emergency Medicine, 2002.PMID 11772667