Failed Intubation — FRCA Final MCQ

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EasyAirway ManagementFailed IntubationFRCA Final

Following induction of general anaesthesia in an adult patient, tracheal intubation is unsuccessful and Plan A is abandoned. A second-generation supraglottic airway device is inserted, and effective ventilation is confirmed by continuous waveform capnography. According to the Difficult Airway Society 2025 algorithm, which statement is correct?

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Correct answer: A — Plan B has succeeded

The correct answer is A. In the DAS 2025 linear difficult-intubation algorithm, Plan A is tracheal intubation and Plan B is ventilation through a supraglottic airway device. Successful insertion of a second-generation device with effective ventilation demonstrated by continuous waveform capnography therefore constitutes successful Plan B, even though the trachea has not been intubated. Plan A has failed because tracheal intubation was unsuccessful. Plan C refers to facemask ventilation and is used if supraglottic-airway ventilation fails. Plan D is emergency front-of-neck airway and is indicated following failure of the preceding oxygenation strategies. Successful oxygenation with a supraglottic airway is a genuine algorithmic success and permits a structured decision about waking the patient, proceeding with surgery, or undertaking another appropriately planned airway intervention.

Reference: Ahmad I, El-Boghdadly K, Iliff H, et al. Difficult Airway Society 2025 guidelines for management of unanticipated difficult tracheal intubation in adults. British Journal of Anaesthesia. 2026;136(1):283-307. https://pubmed.ncbi.nlm.nih.gov/41203471/