Archive September 2017 XVIII, No. 9

Thinking of Buying ... Video Laryngoscopes

For intubations, a new standard of care is within sight.

Richard Cooper

Richard Cooper, BSc, MSc, MD, FRCPC


Video laryngoscopy is poised to replace conventional laryngoscopy as the intubation method of choice. It consistently lets you visualize intubation, something direct laryngoscopy often fails to do. It also improves our clinical documentation with video records.

Stored videos of intubations aren't just useful to subsequent care providers who can use them to see in advance what kinds of difficulties they might encounter. They're also useful to practitioners who want to improve their techniques. Laryngoscopy is so task-focused that we often don't recognize how much we can improve by better understanding how certain difficulties might have been circumvented.

Here are a few considerations to keep in mind if you're shopping for a video laryngoscope.

Familiarity may breed contempt. The video laryngoscope that seems most familiar, or most compatible with your experience in direct laryngoscopy, isn't necessarily going to be the best choice. If you're not experienced with video laryngoscopy, the best choice depends in part on your willingness to learn new techniques. Some video scopes are shaped differently than conventional laryngoscopes. Hyper-angulated blades enable viewing that might not otherwise be possible, but they require a somewhat different technique than conventional Macintosh blades. If you're not prepared to learn the differences, you may end up frustrated, because the scope isn't providing a dramatic improvement over direct laryngoscopy.

Take the time to train. Your anesthesia providers will need proper training when they begin using video laryngoscopes. Being an experienced direct laryngoscopist doesn't necessarily confer expertise when using a video scope.

How well can you see the larynx? High-quality video is nice to have, but I think it's a secondary concern. The key is to be able to see the larynx clearly enough to intubate. If you're doing a diagnostic laryngoscopy, you need a high-resolution image; but if you're attempting to intubate, which is likely to be what you'll most often use the scope for, good laryngeal exposure is more important than image quality. There is, however, an advantage to having a larger screen. The more people in the OR who can see the screen, the greater the potential for valuable support.

Blade sizes. If you're handling neonatal, obstetrical and pediatric patients, as well as adults of all dimensions, you'll either need a scope that can handle an appropriately wide range of sizes — which not all scopes can — or multiple scopes that may differ in the ways they're used. In an emergency, you don't want to have to use a scope that requires a technique you're less familiar with.

Channel challenge. Would you prefer a channeled device or a non-channeled device? Channeled devices may be easier to master, but they're also bulkier, because the endotracheal tube is incorporated into the blade. Non-channeled devices let you manipulate the endotracheal tube and the laryngoscope independently of each other. But they also require better hand-eye coordination.

Reusable or disposable? Should you opt for a single-use device, a reusable device or something in between? The question hinges on how often you'll use a video laryngoscope. Single-use devices may be relatively inexpensive, but if you use them frequently — which, as noted, I think you should — the cost may rival or exceed that of a reusable scope, or one with reusable components. Plus, your reusable scope may actually last several years.

On the other hand, reprocessing a reusable scope takes time — 3 or 4 hours, when you follow manufacturer recommendations. So if cost dictates that you're going to be able to stock only a few scopes, it might be wise to consider single-use devices. Even if you're using them only as rescue devices, you don't want to find yourself needing your reusable scope before it's fully reprocessed. If turnaround time is an issue, the ideal solution may be to stock both types. That way you never end up unable to call on one for a needed rescue. OSM

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