Safe paediatric procedural sedation — branching viva

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]

Branch 1 — pre-sedation assessment and the fasting decision

This child ate a light meal three hours ago. Describe the structured pre-sedation assessment you will perform, and defend your decision to proceed or delay on the basis of fasting status. [2] [5]

Branch 2 — choosing the agent and managing laryngospasm

You choose ketamine. Give me the dose, route and onset. Halfway through the reduction the child develops stridor and paradoxical chest movement — what has happened, and take me through the stepwise management. [3]

Branch 3 — capnography versus pulse oximetry

Why do the guidelines recommend capnography, and what specifically does it detect that pulse oximetry misses? Defend it from the trial evidence. [4]

Closing — recovery and discharge

The reduction is complete. How will you assess recovery, what score will you use, and what are your discharge criteria and your aftercare advice to the family? [2]