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Table 1 Clinical themes and questions

From: The development of a Consensus Conference on Pediatric Procedural Sedation in the Emergency Department in Italy: from here where to?

Q1
P for children and young people under the age of 18 undergoing diagnostic and therapeutic procedures under procedural sedation and analgesia (PSA) in the Emergency Department (ED) provided by non-anesthetists
I what are the factors that determine
C /
O eligibility to receive PSA?
and what is the role of fasting with respect to eligibility for PSA in the ED?
• Which factors should be assessed to justify the use of PSA, rather than no sedation or general anesthesia?
• What validated tools should be used to support assessment?
• Who should make the assessment and how should the assessment be recorded?
• How should the consent for PSA be obtained?
• Should fasting versus no fasting be implemented to prevent adverse outcomes?
Q2
P for children and young people under the age of 18 undergoing diagnostic and therapeutic procedures under PSA in the ED provided by non-anesthetists
I is the administration of midazolam/opioids/nitrous oxide/ketamine/propofol/dexmedetomidine
C compared with usual care/analgesia alone/another sedation drug/psychological technique/general anesthesia
O safe and effective?
• Is midazolam (with or without: analgesia, another drug or psychological techniques) effective and safe for sedation (at minimal, moderate, and deep levels) in comparison with usual care, with analgesia alone, with another sedation drug, with psychological techniques or with general anesthesia?
• Are opioids (with or without: analgesia, another drug or psychological techniques) effective and safe for sedation (at minimal, moderate, and deep levels) in comparison with usual care, with analgesia alone, with another sedation drug, with psychological techniques or with general anesthesia?
• Is 50% nitrous oxide premixed with 50% O2 (with or without: analgesia, another drug or psychological techniques) effective and safe for sedation (at minimal, moderate, and deep levels) in comparison with usual care, with analgesia alone, with another sedation drug, with psychological techniques or with general anesthesia?
• Is ketamine (with or without: analgesia, another drug or psychological techniques) effective and safe for sedation (at minimal, moderate, and deep levels) in comparison with usual care, with analgesia alone, with another sedation drug, with psychological techniques or with general anesthesia?
• Is propofol (with or without: analgesia, another drug or psychological techniques) effective and safe for sedation (at minimal, moderate, and deep levels) in comparison with usual care, with analgesia alone, with another sedation drug, with psychological techniques or with general anesthesia?
• Is dexmedetomidine (with or without: analgesia, another drug or psychological techniques) effective and safe for sedation (at minimal, moderate, and deep levels) in comparison with usual care, with analgesia alone, with another sedation drug, with psychological techniques or with general anesthesia?
Q3
P for children and young people under the age of 18 undergoing diagnostic and therapeutic procedures under PSA in the ED provided by non-anesthetists
I what are the systems and timing of the monitoring and assessment tools for PSA
C /
O more appropriate/useful for each type of PSA?
Q4
P for children and young people under the age of 18 undergoing diagnostic and therapeutic procedures under PSA in the ED provided by non-anesthetists
I what are the available/validated checklists
C /
O for safe conduct of PSA and safe discharge?
Q5
P for non-anesthetists providers of PSA in the ED for children and young people under the age of 18 undergoing diagnostic and therapeutic procedures
I what are the necessary training requirements at an institutional and national level
C /
O to be able to perform safe and effective PSA?
• What generic and specific skills are required for different team members and for different levels of sedation? What training and competences are required?
• Who should train the nurses, doctors and pediatricians of the ED?
Q6
P for children and young people under the age of 18 undergoing diagnostic and therapeutic procedures under PSA in the ED provided by non-anesthetists
I what are the effective strategies
C /
O for successful implementation of non-pharmacologic techniques?
• What standard psychological preparation, coping skills and strategies should be used?
• Can a combination of psychological techniques and sedative drugs help reduce the doses of sedatives?
• What instruments can be used to implement the use of the non-pharmacologic techniques?
Q7
P for adult Emergency Medicine doctors providing PSA in the ED for children and young people under the age of 18 undergoing diagnostic and therapeutic procedures
I what (if any) differences in practice should be applied
C /
O for safe and effective PSA?
• In which way should PSA provided by adult ED physicians, from pre-assessment to discharge, be distinguished from PSA administered by pediatricians/pediatric emergency physicians and how should the differences be managed?
Q8
P for children and young people under the age of 18 undergoing diagnostic and therapeutic procedures in the ED
I is administration of PSA in the ED
C compared to no PSA administration
O effective in optimizing healthcare costs/resource use at a local and a national level and in improving patient experience?
• What impact could the performance of diagnostic and therapeutic procedures under PSA in the ED have on costs (for the patient, for the Institution, for the National Health System)?
  1. Questions on themes 1 to 5 are adapted from the NICE guidelines [4]