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Post-Tonsillectomy Airway Emergency — FRCA Final MCQ

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ModerateAirway ManagementPost-Tonsillectomy Airway EmergencyFRCA Final

A 30-year-old man (ASA I, 70 kg) is having a tonsillectomy under general anaesthesia. Post-extubation he vomits blood-stained material. His SpO2 drops to 88% and he becomes stridulous. What is the most important immediate action?

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Correct answer: B — Perform emergency cricothyroidotomy

Post-tonsillectomy vomiting with blood-stained material, desaturation, and stridor suggests blood/clot in the airway causing partial obstruction. The immediate priority is: suction the oropharynx and nasopharynx (under direct vision if possible), position the patient head-down in the lateral/recovery position to allow blood to drain away from the airway, and apply 100% oxygen. If simple measures fail and the airway deteriorates, re-intubation with a smaller ETT and RSI is required. These patients are at high risk of aspiration of blood.

Reference: RCOA – 2023 – ENT anaesthesia module; Resuscitation Council UK – 2021 – Choking/airway obstruction