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Failed intubation with maintained oxygenation — FRCA Final MCQ

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HardGeneral AnaesthesiaFailed intubation with maintained oxygenationFRCA Final

A 58-year-old man with treated hypertension is undergoing emergency laparotomy for bowel obstruction. After rapid sequence induction, two laryngoscopy attempts with a videolaryngoscope give a Cormack-Lehane grade 3 view. Mask ventilation remains possible, SpO2 is 97%, and the surgeon confirms that surgery can be delayed. What is the most important next step?

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Correct answer: A — Declare failed intubation and wake the patient

Oxygenation is maintained and the operation is not immediately life-saving, so the safest step after failed intubation is to declare failure, stop further attempts and wake the patient. Repeated laryngoscopy risks airway trauma, oedema and a later cannot oxygenate situation. A supraglottic airway may be useful as a rescue oxygenation device, but it should not be used here to continue a non-urgent laparotomy. The teaching point is that the airway plan should prioritise oxygenation and timely progression through the difficult-airway algorithm.

Reference: DAS 2025 adult unanticipated difficult tracheal intubation guideline