Airway management: Pierre Robin sequence: 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: Pierre Robin sequence

Sample item

A neonate with Pierre Robin sequence (micrognathia and glossoptosis) needs general anaesthesia for a cleft palate procedure. Which strategy is preferred for securing the airway?

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

The answer and the reasoning

B. Maintain spontaneous ventilation with sevoflurane and avoid muscle relaxants until the airway is secured

The small mandible and posteriorly displaced tongue make laryngoscopy and mask ventilation difficult, and loss of tone can cause complete obstruction. Spontaneous ventilation under inhalational anaesthesia keeps the tongue tone and allows a rescue plan, using videolaryngoscopy, fibreoptic equipment or a supraglottic device. Relaxants are given only after the airway is confirmed.

Option by option

  • A. Give a relaxant first to improve laryngoscopic view

    Relaxation removes airway tone and can make mask ventilation impossible.

  • B. Maintain spontaneous ventilation with sevoflurane and avoid muscle relaxants until the airway is secured (correct)

    Correct. Preserved spontaneous breathing gives a safety margin in a predicted difficult airway.

  • C. Give propofol and rocuronium and attempt direct laryngoscopy

    Paralysis before the airway is secured risks a cannot intubate cannot oxygenate situation.

  • D. Use suxamethonium for rapid sequence induction

    Suxamethonium in a neonate with a difficult airway adds risk without improving the view.

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.

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Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is B, Maintain spontaneous ventilation with sevoflurane and avoid muscle relaxants until the airway is secured. The small mandible and posteriorly displaced tongue make laryngoscopy and mask ventilation difficult, and loss of tone can cause complete obstruction.

Why is "Give a relaxant first to improve laryngoscopic view" not the answer?

Relaxation removes airway tone and can make mask ventilation impossible.

Why is "Give propofol and rocuronium and attempt direct laryngoscopy" not the answer?

Paralysis before the airway is secured risks a cannot intubate cannot oxygenate situation.

Why is "Use suxamethonium for rapid sequence induction" not the answer?

Suxamethonium in a neonate with a difficult airway adds risk without improving the view.

What concept does this question test?

It tests Airway management: Pierre Robin sequence in Anaesthesia. Spontaneous ventilation under inhalational anaesthesia keeps the tongue tone and allows a rescue plan, using videolaryngoscopy, fibreoptic equipment or a supraglottic device. Relaxants are given only after the airway is confirmed.

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: Pierre Robin sequence?

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.