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Deep Neck Abscess Airway Child — FRCA Final MCQ

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HardPaediatric AnaesthesiaDeep Neck Abscess Airway ChildFRCA Final

A 10-year-old child weighing 30 kg requires emergency drainage of a left parapharyngeal abscess. He has a muffled voice and an inter-incisor distance of 12 mm. CT demonstrates moderate lateral displacement of the pharynx but patent nasal passages, with no laryngeal oedema or tracheal compression. He has no stridor, recession or drooling, can lie supine, and has an SpO2 of 95% on air. He is frightened and cannot cooperate with awake airway topicalisation. In a specialist paediatric theatre with senior ENT assistance and immediate surgical-airway capability, which is the most appropriate primary airway plan?

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

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Correct answer: E — Sevoflurane induction preserving spontaneous ventilation followed by nasal flexible-scope intubation

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

C is the best primary plan. Severe trismus makes oral laryngoscopy unreliable, while the patent nasal route permits flexible-scope intubation. Because this child cannot cooperate with an awake technique, gradual sevoflurane induction while preserving spontaneous ventilation provides a margin for continued oxygenation until the trachea is secured; neuromuscular blockade may be given only after capnographic confirmation. This must occur with senior paediatric anaesthetic and ENT personnel and an immediately available rescue surgical airway. Rapid-sequence induction removes spontaneous ventilation before airway security. Propofol may abruptly reduce pharyngeal tone and cause obstruction. Awake fibreoptic intubation would be attractive in a cooperative older child but is not feasible here. Primary awake tracheostomy is disproportionate without stridor, respiratory distress or critical airway compression.

Reference: Dhanger S et al. Precision in Planning: Airway Battles in Pediatric Temporomandibular Joint Ankylosis. 2026. https://pubmed.ncbi.nlm.nih.gov/42021501/