The video laryngoscope is, in my opinion, a beautiful and functional piece of equipment. The addition of visual assistance to a standard laryngoscope blade can help your anesthesia providers better navigate patient airways for intubation in routine or emergency situations. There's a lot of neat technology out there. Buying the instruments may require some calculations on your part regarding their use and cost, though ultimately the decision comes down to patient safety. Here's a look at the factors involved.

Ease of use
Generally speaking, the video laryngoscope resembles a conventional laryngoscope with a Macintosh blade, with the addition of camera optics to the tip of the blade. Depending on the product, the camera delivers images to an external monitor, in the fashion of a laparoscopic camera, or to a small video screen built into the scope handle itself.

If you're in the market to equip your ORs with video laryngoscopes, above all else you're looking for a device that will be easy for your anesthesia providers to use. As with many other types of surgical equipment, that means something that they're familiar with and comfortable using. Ask your anesthetists which instruments they've used at the hospitals they've worked at, or which products resemble other pieces of equipment they're already trained to use. The closer the video laryngoscope resembles what is used every day, the better the results will be, since there won't be as many new skills or techniques required for its operation.

Trialing the instruments is, of course, also critical to making the right choice. Most manufacturers are willing to lend demonstration models, with their representatives bringing them to your ORs to try out for a few days. You're looking for something effective and reliable. How quickly and easily can it go from the packaging to clinical use? Is it a single piece, or five pieces that require assembly? Does it plug into the monitor for immediate use, or does it take a few seconds for the optics to warm up? What's the quality of the resulting image, and how well does it maneuver to get the view you want to see?

Some video laryngoscopes are disposable, some are made for multiple reuse, and some have single-use and limited reusable components. If you're considering a reusable or partially reusable instrument, keep in mind that reprocessing methods differ from product to product. You'll want to refer to the manufacturer's directions and consult with your sterile processing personnel to make sure your facility is set up with the proper equipment. You don't want to put the instrument into the autoclave, for instance, and melt it down.

The cost of practice
Video laryngoscopes are generally considered difficult airway equipment, designed for use when an anesthesia provider can't insert an endotracheal tube through conventional methods. As a result, rapid and effective use is critical, and their use is only as effective as the clinician who's been trained to use them. In this case, practice really does make perfect. The more the device is used, the quicker its use will be and the greater the chances of success; but if a clinician is lacking in video laryngoscope practice, it's questionable how effective the instrument will be when a clinician reaches for it in an emergency.

Here's the catch: Video laryngoscopes can have an expensive learning curve, particularly if you're leaning toward purchasing a model that's single-use or includes single-use components. The instruments and technology may be very good, but how much money will your equipment and supply budget allow you to spend on disposable items for practice? How many times will you let an anesthesia provider try out a device before your materials manager has to draw the line?

Granted, it's a piece of equipment that only a select few people at the facility will be trained to use. They'll be the go-to experts, the key educators for the rest of the staff on difficult airways and airway management equipment. But what buyers may overlook is that new anesthesia personnel who come to your facility will also need to be trained on the instruments, so practice might not be a one-time expense. Be sure to negotiate with the vendor or distributor on the possibility of their participation in future practice in-services, or perhaps depending on the volume of disposables purchased, a few more free for practice.

One question to keep in mind if you're considering video laryngoscopes: What types of patients are you serving? For smaller outpatient surgery facilities that host only elective procedures for which the anesthesia provider has rigorously pre-screened patients for the possibility of difficult airways, the price of an instrument intended mainly for rare emergencies may be difficult to justify. Administrators and material managers at such facilities might instead consider a fiberoptic bronchoscope. While the instrument is generally more expensive than a video laryngoscope, at $12,000 to $18,000, its reusability can recoup that cost while also allowing for plenty of practice.

Clarus Medical
Clarus Video System
(763) 525-8417
www.clarus-medical.com
List price: $6,950
FYI: This "Swiss Army knife for airway management" offers the benefits of a malleable stylet, a disposable laryngoscope blade and a flexible and detachable endoscope, says the company. It can also serve as a video exchange tube catheter when changing tubes or extubating. LED lights provide illumination. FDA approval is pending on a single-use sheath that provides uninterrupted use.

Gyrus ACMI
ENF-VQ Video Laryngoscope
(901) 373-0200
www.olympusamerica.com/oai_medical.asp
List price: $21,395
FYI: You'll get clear, bright, high-resolution and full-screen images with this slim, compact instrument, says Gyrus ACMI (recently acquired by Olympus). Olympus's Narrow Band Imaging technology , which enhances visualization of mucosal structures, offers improved views of difficult-to-distinguish anatomical structures and fine capillary patterns.

King Systems
Airtraq
(800) 642-5464
www.kingsystems.com
List price: not disclosed
FYI: This high-definition optical system provides a magnified view during routine and complex airway use, says the company. The easy-to-insert Airtraq has a built-in anti-fog system and low-temperature light source, and can be equipped with a small, reusable clip-on video system that connects to an external monitor. It's available in standard and small sizes, as well as nasotracheal and double-lumen tube configurations.

LMA North America
McGrath Series 5 Video Laryngoscope
(800) 788-7999
www.lmana.com
List price: $9,295
FYI: Designed to provide a clear view of the vocal cords during intubation with little or no change in laryngoscope technique, the McGrath aims to simplify difficult airway intubation and minimize the lifting forces often necessary for successful intubation even on routine airways, says the company. A small camera with a powerful light source is located at the distal end of the blade, letting you view the airway anatomy in real time on a color display as you guide the endotracheal tube through the vocal cords and into the larynx.

Pentax Medical Company
Pentax-AWS Video Intubating Laryngoscope
(800) 262-8462
www.ambuusa.com
List price: not disclosed
FYI: The Pentax-AWS Video Intubating Laryngoscope (distributed in the United States by Ambu, Inc.) combines advanced imaging technology with ergonomic design for fast and accurate placement of endotracheal tubes, says the manufacturer. High-resolution images and the Pentax PBlade rigid laryngoscope blade allow for quality visualization without extending the head or neck. Plus, a unique on-screen targeting system highlights the intended path of an endotracheal tube to minimize trauma to anatomical structures.

Teleflex Medical
R??sch Truview EVO
(866) 246-6990
www.myrusch.com
List price: $950 to $2,995
FYI: This optical view laryngoscope blade is designed to provide indirect laryngoscopy with continuous oxygen insufflation more safely, clearly and easily, says the company. Indicated for use in both standard and difficult intubations and sized for both adults and infants, it illuminates and expands the angular view of the larynx and adjacent structures, thereby facilitating endotracheal intubation.

Verathon
GlideScope Video Laryngoscopes
(800) 331-2313
www.verathon.com
List price: varies depending on configuration
FYI: Designed for difficult and unpredictable airways, the GlideScope provides a clear, real-time view of a patient's anatomy and endotracheal tube placement, says the company. Operational in seconds, the device features an integrated high-resolution camera, an anti-fogging mechanism to resist lens contamination, a non-glare color monitor and unique blade angulation. The reusable GVL and the single-use GlideScope Cobalt Video Laryngoscope are both available in four sizes, from infant to morbidly obese patients.