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Epiglottitis Airway Management — FRCA Final MCQ

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HardPaediatric AnaesthesiaEpiglottitis Airway ManagementFRCA Final

A 5-year-old child weighing 20 kg presents with fever, a toxic appearance, drooling, inspiratory stridor and an oxygen saturation of 92% on air. Acute epiglottitis with impending airway obstruction is suspected. The child remains upright on a parent's lap and oxygen is offered without causing distress. Senior anaesthetic and ENT clinicians are present, and an operating theatre is immediately available. Which airway management plan is most appropriate?

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Correct answer: B — Transfer monitored to theatre and induce deeply with sevoflurane while maintaining spontaneous ventilation, with ENT ready for surgical airway

The correct answer is B. This child has severe epiglottitis with impending complete obstruction. He should remain calm and upright and undergo controlled airway management in theatre by the most experienced anaesthetist, with ENT present and immediate surgical-airway capability. The canonical FRCA technique is deep inhalational induction with sevoflurane in an oxygen-rich mixture while preserving spontaneous ventilation until the airway is secured. This is hazardous and requires a pre-agreed rescue plan. Oropharyngeal examination and radiography may provoke agitation or delay airway control. Nebulised adrenaline is principally a temporising treatment for croup and must not defer securing this airway. Intravenous access and antibiotics follow airway control unless access is already present without distress; propofol, neuromuscular blockade and positive-pressure ventilation could convert partial obstruction into an unmanageable complete obstruction.

Reference: Royal College of Anaesthetists. Guide to the FRCA Examination, SBA Paper 1 Question 3 and answer: inflammatory upper-airway obstruction/acute epiglottitis. 2020. https://www.rcoa.ac.uk/media/49226