A parturient at 38 weeks gestation requires emergency Caesarean section under general anaesthesia. She is classified as high risk for aspiration. The MOST appropriate induction sequence is:

• A Inhalational induction with sevoflurane to avoid airway manipulation
• B Ketamine 2 mg/kg IV and vecuronium 0.1 mg/kg with awake intubation
• C Midazolam 0.1 mg/kg IV followed by rocuronium 0.6 mg/kg; no cricoid pressure
• D Rapid sequence induction with thiopentone 4–5 mg/kg and succinylcholine 1.5 mg/kg, with cricoid pressure ✓

Explanation

Parturients are at high risk for pulmonary aspiration of gastric contents due to raised intra-abdominal pressure, reduced lower oesophageal sphincter tone, and delayed gastric emptying. Rapid sequence induction (RSI) with thiopentone (or propofol) and succinylcholine, combined with cricoid pressure, is the standard technique for emergency GA Caesarean section to achieve rapid unconsciousness and secured airway within the shortest interval. Succinylcholine provides rapid-onset complete intubating conditions within 60 seconds, minimising the unprotected airway window. Inhalational induction is too slow and unsuitable for aspiration prophylaxis.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.