Category 1 CS Anaesthetic Choice — FRCA Final MCQ

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EasyObstetric AnaesthesiaCategory 1 CS Anaesthetic ChoiceFRCA Final

A 28-year-old woman (ASA I, 60 kg) at 38 weeks gestation has a confirmed category 1 caesarean section for cord prolapse. No epidural is in situ. The estimated decision-to-delivery interval target is <30 minutes. What is the most appropriate anaesthetic technique?

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Correct answer: D — General anaesthesia with RSI

Category 1 caesarean section (immediate threat to life of woman or fetus) with no functioning epidural in situ requires general anaesthesia with rapid sequence induction. This provides the fastest anaesthetic onset (decision-to-delivery target <30 minutes). Spinal anaesthesia can be performed for cat 1 sections in experienced hands (and may be faster than GA if the anaesthetist is ready), but in the context of cord prolapse with potential fetal compromise, GA with RSI is the standard approach to achieve the fastest delivery. The OAA/DAS 2015 guidelines should be followed for the obstetric airway.

Reference: NICE – 2021 – NG192 Caesarean birth; OAA/DAS – 2015 – Obstetric airway guidelines; RCOA GPAS – 2025 – Chapter 9