Thread by @dastrainees

#JanuAIRWAY Day 23 (the final stretch!). Malacias and SVC Obstruction. Here's a pair of #OnePagers to get started..
#JanuAIRWAY 1/10

What are malacias? = rare dynamic airway obstruction - (congenital / acquired) due to loss of cartilaginous support
Decreased intratracheal pressure + increased intrathoracic pressure lead to airway compression
Severity is proportional to expiratory force
#JanuAIRWAY 2/10

Issues
Obstruction can occur even if aymptomatic
Maintain spont. Vent. if poss
Emergency management =+ve pressure (splint airways open) or bypass obstruction
Surgery depends on location / extent
Extubate deep (avoid coughing) or directly to CPAP
#JanuAIRWAY 3/10

SVC Obstruction – below thoracic inlet- Cancer/Vascular/Infection/Thrombosis.
Pemberton’s sign useful (face flushing on raising arms– pic)
Valsalva challenge- if syncope = risk of complete vascular obstruction
Severe cases need Rx (IR stent) BEFORE GA
#JanuAIRWAY 4/10

SVC Obstruction – Airway Options
Depends on level /degree of obstruction
At / above thoracic inlet - Standard laryngoscopy / Jet ventilation / Rigid Bronchoscope
Below thoracic inlet - Awake technique / Jet vent. / Rigid Bronchoscope
#JanuAIRWAY 5/10

SVC Obstruction – if no Rx pre-op
Pt sat up + High flow O2
Large bore, lower limb IV Access – consider RIC / Swann Introducer
Art.line -?lower limb also
Smooth IV induction-avoid coughing (may be slow)
Possible cerebral oedema/slow wake-up/recovery
#JanuAIRWAY 6/10

Bonus: Bleeding & Airways
- 3 routes; wound (haematoma/oedema), into airway (above glottis/oesophagus) or from airway
- If from above glottis/oesphag – ?isolate glottis with iGel, then ?FOI – see pic
- Great review – Kristensen & McGuire in links
#JanuAIRWAY 7/10

Airway obstruction due to neck haematoma
- Can be fatal
- Normally due to laryngeal oedema NOT tracheal compression
- Need to open wound to relieve pressure – SCOOP

See the @dasairway @BAETS_UK and @ENT_UK guidelines in @Anaes_Journal
🔗…-publications.onlinelibrary.wiley.com/doi/10.1111/an…
#JanuAIRWAY 8/10

Here are some papers / links that you might find interesting:
🔗onlinelibrary.wiley.com/doi/abs/10.104…
🔗bjanaesthesia.org.uk/article/S0007-…
🔗aeronline.org/article.asp?is…
🔗ncbi.nlm.nih.gov/pmc/articles/P…
🔗pubs.asahq.org/anesthesiology…
🔗pubmed.ncbi.nlm.nih.gov/31549341/
🔗ncbi.nlm.nih.gov/pmc/articles/P…
#JanuAIRWAY 9/10

Tomorrow we’ll look at the paediatric airway (ft. expert contributions from Adam Donne/ Alistair Baxter). See you then! #JanuAIRWAY 10/10

*Disclaimer: Inclusion of content (equipment, techniques and scoring systems etc.) in #JanuAIRWAY does not constitute DAS endorsement