A 75-year-old man  has suffered chest trauma with multiple  fractured ribs after falling off a ladder. There is no other significant  injury after a tertiary survey  and  a trauma radiology series. His past history includes a history of depression treated with sertraline, chronic renal dysfunction  with a creatinine of 190 µmol/L (normal range 60-120 µmol/L) and  a heavy (10 standard drinks/day) alcohol consumption. He has just arrived in the ICU via radiology and is intubated and ventilated.
 
1.  For this  patient,  what  are the  pharmacological  options  that  you would  consider  for adequate sedation and analgesia, and why would you choose them?
 
The rest of the viva focussed on the value of daily cessation of sedation, the management of encephalopathy and the pharmacology of dexmedetomidine.
 
Areas of weakness identified by examiners:
Few candidates seemed to have a structured approach and some were not familiar with dexmedetomidine and the recent trial data. No broad overview of sedation and analgesia agents with reference to the above patient considering the simplicity of the question. Many not familiar with dexmedetomidine pharmacology regardless of practical experience with the drug

Disclaimer: the viva stem above is the original CICM stem, acquired from their publicly available past papers. However, because the college do not make the rest of the viva text or marking criteria available, the rest has been confabulated. It sounds like a plausible viva and it can be used for the purpose of practice, but all should be aware that it does not represent the "true" canonical CICM viva station.