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DAS 2025 VL Recommendation — FRCA Final MCQ

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HardAirway ManagementDAS 2025 VL RecommendationFRCA Final

An adult patient requires emergency surgery under general anaesthesia. Following airway assessment and team discussion, awake tracheal intubation is not indicated and asleep tracheal intubation is planned. The operator is trained in all the listed techniques and all devices are immediately available. According to the Difficult Airway Society 2025 guidelines for unanticipated difficult tracheal intubation in adults, which device should be selected first-line for the initial tracheal intubation attempt?

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

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Correct answer: B — Videolaryngoscope

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

B is correct. First-line videolaryngoscopy is a key change in the DAS 2025 adult guidelines, reflecting a shift towards preventing failure and maximising first-attempt tracheal intubation success. Direct laryngoscopy is therefore no longer the default first-line device when appropriate videolaryngoscopy equipment and expertise are available. A flexible intubation scope may be selected for awake intubation or particular anatomical problems, but it is not the routine first-line device for an asleep Plan A attempt. A rigid optical stylet is an alternative specialist technique rather than the guideline default. A second-generation supraglottic airway device belongs principally to Plan B rescue ventilation after unsuccessful tracheal intubation, although it may subsequently serve as an intubation conduit.

Reference: Ahmad I 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/