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Previous Difficult Intubation Plan — FRCA Final MCQ

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ModerateAirway ManagementPrevious Difficult Intubation PlanFRCA Final

A 55-year-old man (ASA III) with a history of a previous difficult intubation (Cormack-Lehane 3b documented) is scheduled for elective hernia repair. He has no features suggesting a change in airway status. According to current practice, what should his airway management plan include?

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Correct answer: A — Videolaryngoscopy as first attempt with a bougie available

For a patient with a documented previous difficult intubation but no indication for awake intubation (no aspiration risk, not anticipated impossible intubation), the DAS 2025 guidelines support videolaryngoscopy as first-line with immediate availability of a bougie, optimised positioning, and a clear Plan A through D. The key is preparation: reviewed airway assessment, senior anaesthetist, equipment checked, and a documented plan shared with the team. An awake technique is reserved for anticipated impossible intubation or high aspiration risk scenarios.

Reference: DAS – 2025 – Difficult intubation guidelines; RCOA – 2023 – Airway management