Paediatric Day Surgery Recovery, Emergence Delirium, PONV, and Post-Extubation Airway Crises — WACS Viva & Clinical Scenarios (Paediatrics & Day Care)

Exam-style paediatric day surgery recovery, emergence delirium, ponv, and post-extubation airway crises viva scenarios with examiner probes and model answers…

Scenarios covered

• SCENARIO 1: Immediately following extubation at the conclusion of an adenoidectomy, a 3-year-old boy (15 kg) develops complete upper airway obstruction. There is paradoxical chest wall motion, absence of breath sounds on auscultation, loss of EtCO₂ tracing, and his SpO₂ rapidly plummets from 99% to 70%, with heart rate falling to 55 bpm. Detail your step-by-step emergency management of this life-threatening post-extubation laryngospasm.
• SCENARIO 2: A 4-year-old girl is admitted to the PACU following uneventful sevoflurane anaesthesia and caudal block for bilateral inguinal herniotomy. Within 5 minutes of awakening, she is violently thrashing, screaming, kicking, combative, and does not recognize her mother. How do you assess, differentiate, treat, and prevent this episode of paediatric emergence delirium?
• SCENARIO 3: A 6-year-old boy undergoing day-case strabismus surgery has a high risk of Postoperative Nausea and Vomiting (PONV). Outline your comprehensive multi-modal strategy for PONV prevention and treatment, detailing the pharmacological mechanisms, exact paediatric dosing, timing of administration, and rescue therapies in the recovery unit.
• SCENARIO 4: A 2-year-old toddler who had a tight-fitting uncuffed endotracheal tube in place for a 3-hour plastic surgical procedure develops progressive biphasic stridor, tachypnoea, and intercostal retractions 45 minutes after arrival in the PACU. How do you diagnose and manage post-extubation subglottic oedema, and what are your criteria for safe discharge versus hospital admission?