Airway management: needle cricothyroidotomy in children: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anaesthesia · Airway management: needle cricothyroidotomy in children

Sample item

A 4-year-old with an impacted foreign body at the glottis cannot be intubated, and SpO2 is falling despite bag-mask ventilation. What is the preferred emergency front-of-neck access?

ARetrograde intubationBElective tracheostomyCSurgical cricothyroidotomy with a 6 mm tubeDNeedle cricothyroidotomy with a large cannula

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Needle cricothyroidotomy with a large cannula

In children, surgical cricothyroidotomy is avoided because the cricothyroid membrane is tiny and the cricoid is narrow and easily damaged. Needle cricothyroidotomy with a 14 to 16 gauge cannula, with oxygen insufflation, is used instead as a bridge. Tracheostomy takes too long in an emergency.

Option by option

A. Retrograde intubation
Retrograde intubation needs time and a patent glottis, which this child does not have.
B. Elective tracheostomy
Tracheostomy is too slow in an acute hypoxic emergency.
C. Surgical cricothyroidotomy with a 6 mm tube
A surgical technique with a larger tube risks damaging the small cricoid.
D. Needle cricothyroidotomy with a large cannula (correct)
Correct. A cannula through the membrane is the safe emergency route in a young child.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is D, Needle cricothyroidotomy with a large cannula. In children, surgical cricothyroidotomy is avoided because the cricothyroid membrane is tiny and the cricoid is narrow and easily damaged.

Why is "Retrograde intubation" not the answer?

Retrograde intubation needs time and a patent glottis, which this child does not have.

Why is "Elective tracheostomy" not the answer?

Tracheostomy is too slow in an acute hypoxic emergency.

Why is "Surgical cricothyroidotomy with a 6 mm tube" not the answer?

A surgical technique with a larger tube risks damaging the small cricoid.

What concept does this question test?

It tests Airway management: needle cricothyroidotomy in children in Anaesthesia. Needle cricothyroidotomy with a 14 to 16 gauge cannula, with oxygen insufflation, is used instead as a bridge. Tracheostomy takes too long in an emergency.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Airway management: needle cricothyroidotomy in children?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.