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Neuromuscular Block for Intubation — FRCA Final MCQ

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ModerateAirway ManagementNeuromuscular Block for IntubationFRCA Final

An ASA I adult requires tracheal intubation after induction of general anaesthesia. Facemask ventilation is straightforward, there is no contraindication to a neuromuscular blocking agent, and laryngoscopy has not yet been attempted. According to the Difficult Airway Society 2025 guidelines, which approach to neuromuscular block best supports successful intubation at the first attempt?

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

Reveal the answer and explanation

Correct answer: E — Administer neuromuscular block early to optimise intubating conditions

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

B is correct. The DAS 2025 strategy emphasises proactive optimisation to maximise first-attempt tracheal intubation success; earlier administration of neuromuscular block is one of its key updates. Neuromuscular blockade improves jaw relaxation and vocal-cord conditions and reduces coughing or movement during tube passage. Easy facemask ventilation does not make paralysis unnecessary, so A is incorrect. Waiting for a failed attempt, as in C, forfeits the opportunity to optimise the first attempt. DAS does not mandate suxamethonium exclusively: an appropriate depolarising or non-depolarising agent may be selected according to the patient and clinical context, making D incorrect. Neuromuscular block is also not confined to rapid sequence induction, so E is incorrect.

Reference: Jagannathan N, Aziz MF. Difficult Airway Society 2025 guidelines for tracheal intubation: thoughtful preparation for success and systematic management of failure. British Journal of Anaesthesia. 2026;136(1):9-11. https://pubmed.ncbi.nlm.nih.gov/41339170/