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Oxygen Pipeline Failure — FRCA Final MCQ

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ModerateAnaesthetic Equipment & SafetyOxygen Pipeline FailureFRCA Final

A 45-year-old man (ASA I) has been anaesthetised, tracheally intubated and mechanically ventilated for elective knee arthroscopy. Before surgery begins, the oxygen pipeline supply alarm sounds and the pipeline pressure gauge falls to zero. The reserve oxygen cylinder attached to the anaesthetic machine reads 100 bar. What is the most appropriate immediate action?

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Correct answer: C — Open the reserve oxygen cylinder, confirm oxygen delivery and reduce oxygen consumption while calling for help

The immediate priority is to restore a reliable oxygen supply: open the reserve cylinder, verify inspired oxygen delivery and conserve the finite supply by reducing fresh-gas flow and avoiding unnecessary oxygen-driven equipment. Call for help and alert the theatre team. Whether this elective procedure should subsequently be abandoned is a separate decision based on cylinder capacity, the extent and likely duration of the failure, and availability of another reliable oxygen source. Waking the patient before restoring oxygen risks hypoxaemia. Investigation of the pipeline must not delay patient management, and air-only ventilation is unsafe. A self-inflating bag is the correct fallback if the anaesthetic machine cannot deliver oxygen or ventilate reliably, but confirmed isolated pipeline failure with an available machine cylinder does not initially require abandoning the machine.

Reference: Royal College of Anaesthetists. Mains Oxygen Failure – Critical Incidents simulation, reviewed December 2022, published 2023. https://www.rcoa.ac.uk/sites/default/files/documents/2023-10/Critical%20Incidents%20-%20Mains%20oxygen%20failure%200923.pdf