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Post-Tonsillectomy Haemorrhage Airway — FRCA Final MCQ

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HardAirway ManagementPost-Tonsillectomy Haemorrhage AirwayFRCA Final

A 30-year-old man (ASA I) is recovering from a tonsillectomy. Six hours later he presents with haematemesis and active bleeding from the tonsillar fossa. He has lost approximately 800 mL of blood. HR 120, BP 90/55. He requires a return to theatre for haemostasis. What is the most critical airway consideration?

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Correct answer: C — Full stomach (swallowed blood) AND potentially difficult laryngoscopy due to blood/clot in the pharynx – requires an experienced anaesthetist

Post-tonsillectomy haemorrhage requiring return to theatre is a high-risk anaesthetic scenario because of: (1) FULL STOMACH from swallowed blood (aspiration risk – RSI mandatory), (2) hypovolaemia (may be significant – resuscitate before induction), (3) difficult laryngoscopy (blood/clot obscuring the view, oedematous pharynx), and (4) potential for cardiovascular collapse on induction. Two large-bore IV cannulae, blood crossmatched, experienced anaesthetist, head-down tilt for blood drainage, and a robust suction system are essential. This is a recognised high-mortality scenario.

Reference: RCOA – 2023 – ENT emergency anaesthesia; NAP4 – 2011 – Post-tonsillectomy haemorrhage