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Difficult Airway Plus Full Stomach Priority — FRCA Final MCQ

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HardAirway ManagementDifficult Airway Plus Full Stomach PriorityFRCA Final

A 72-year-old woman (ASA III) with a large incisional hernia containing bowel requires emergency repair. She has a BMI of 40 and known difficult airway (previous failed intubation). The surgical team request general anaesthesia with muscle relaxation. Given her difficult airway and full stomach, what is the recommended approach?

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Correct answer: A — Awake fibreoptic intubation despite the aspiration risk

In a patient with a documented difficult airway (previous failed intubation) AND a full stomach (emergency with bowel obstruction), the competing risks of aspiration vs failed intubation must be weighed. The difficult airway takes priority: a failed intubation/CICO scenario is more immediately life-threatening than aspiration risk. Awake fibreoptic intubation preserves airway reflexes (reducing aspiration risk compared to unconscious techniques), maintains spontaneous ventilation, and allows controlled intubation. Preparation includes: anti-sialagogue, topical anaesthesia, suction ready, and a surgical airway backup plan.

Reference: DAS – 2025 – Difficult intubation; DAS – 2020 – Awake tracheal intubation