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Cricoid Pressure in Obstetric RSI — FRCA Final MCQ

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ModerateObstetric AnaesthesiaCricoid Pressure in Obstetric RSIFRCA Final

An anaesthetist performs rapid sequence induction for an emergency caesarean section. The assistant applies cricoid pressure, but the first tracheal intubation attempt fails with an inadequate laryngeal view. According to the OAA/DAS obstetric difficult-airway guideline, how should cricoid pressure be managed if it is contributing to the difficulty?

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

Reveal the answer and explanation

Correct answer: E — Reduced or released if it impedes laryngoscopy or intubation

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

The correct answer is B. The OAA/DAS obstetric airway guideline advises early reduction or release of cricoid pressure when airway management becomes difficult because incorrectly directed or excessive force may distort the larynx and obstruct laryngoscopy, tracheal tube passage, mask ventilation or supraglottic airway insertion. Maintaining cricoid pressure regardless of its effect (A) may therefore worsen airway failure. Waiting until two attempts have failed (D) delays an important optimisation step. Increasing the force to 40 N (E) is not recommended and may increase distortion. Pressure over the thyroid cartilage (C) describes external laryngeal manipulation, which may be directed by the laryngoscopist but is not an automatic substitute for appropriately managed cricoid pressure.

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