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Cannot intubate cannot oxygenate — FRCA Final MCQ

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HardGeneral AnaesthesiaCannot intubate cannot oxygenateFRCA Final

A 43-year-old woman with obesity is anaesthetised for incision and drainage of a neck abscess. Direct and videolaryngoscopy have failed, a second-generation supraglottic airway will not ventilate, and two-person mask ventilation gives no chest movement. SpO2 has fallen from 92% to 78% despite 100% oxygen. What is the most appropriate anaesthetic technique?

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Correct answer: E — Perform scalpel-bougie-tube front-of-neck airway

This is a cannot intubate, cannot oxygenate situation, and immediate emergency front-of-neck access is indicated. Waiting for reversal or attempting further upper-airway techniques risks severe hypoxic injury. A smaller supraglottic device is suboptimal after a failed rescue supraglottic airway and absent ventilation. The clinical pearl is that the threshold for front-of-neck airway should be low once oxygenation is failing.

Reference: DAS 2025 adult unanticipated difficult tracheal intubation guideline; RCoA NAP4