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Failed Intubation in Obstetrics — FRCA Final MCQ

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HardObstetric AnaesthesiaFailed Intubation in ObstetricsFRCA Final

A term parturient requires a category 1 caesarean delivery for persistent fetal bradycardia. General anaesthesia is induced by a consultant anaesthetist. She has a BMI of 27 kg.m−2, is appropriately fasted, has no reflux symptoms or other additional aspiration-risk features, and surgery is expected to be straightforward. There is no functioning neuraxial catheter. After one failed direct-laryngoscopy attempt and one failed videolaryngoscopy attempt, failed tracheal intubation is declared. An i-gel is inserted; continuous capnography, bilateral chest movement and an oropharyngeal leak pressure of 30 cmH2O confirm effective ventilation, and its gastric drain channel is patent. According to the OAA/DAS obstetric failed-intubation guidelines, what is the most appropriate next step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Proceed with surgery using the supraglottic airway

Explanation lettering: E = shown as A · C = shown as B · B = shown as C · A = shown as D · D = shown as E

B is correct. Once the i-gel has restored reliable oxygenation and ventilation, this is not a cannot-intubate, cannot-oxygenate situation, so emergency front-of-neck access is not indicated. OAA/DAS requires an explicit wake-or-proceed assessment based on urgency, operator seniority, obesity, surgical complexity, aspiration risk, feasibility of alternative anaesthesia and airway reliability. Persistent fetal bradycardia, category 1 urgency, consultant involvement, limited additional aspiration risk, straightforward surgery, absence of a neuraxial option and effective ventilation through a second-generation supraglottic airway all favour proceeding. Waking for awake intubation or regional anaesthesia would delay delivery and is favoured when urgency is lower or the risks of continuing are greater. Blind intubation through the i-gel risks trauma and loss of the established airway; further uncontrolled attempts should be avoided.

Reference: Mushambi MC, Kinsella SM, Popat M, et al. Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics. Algorithm 2 and Tables 1–2. Anaesthesia. 2015;70:1286–1306. https://pubmed.ncbi.nlm.nih.gov/26449292/