skip to main content

Desaturation During Prone Sedation — FRCA Final MCQ

Instant feedback + full explanation. One question, done properly.

ModerateGeneral AnaesthesiaDesaturation During Prone SedationFRCA Final

A 65-year-old man (ASA III) is undergoing endoscopic retrograde cholangiopancreatography (ERCP) in the prone position under deep sedation with propofol. He desaturates to 82%. The endoscopist requests you manage the situation. What is the most important immediate action?

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

Reveal the answer and explanation

Correct answer: B — Reduce the propofol infusion rate and turn supine

In a prone/semi-prone patient who desaturates during sedation, the priority is to reduce or stop the sedative (to restore spontaneous ventilation), turn the patient supine (to allow standard airway management), and optimise oxygenation. Managing the airway in the prone position is extremely challenging. While simple manoeuvres (jaw thrust, nasopharyngeal airway) can be attempted in the prone position temporarily, definitive management requires the supine position for bag-mask ventilation, SAD insertion, or intubation if needed.

Reference: RCOA – 2023 – Sedation guidelines; Academy of Royal Medical Colleges – 2013 – Safe sedation practice