Anesthesia providers are trained to always anticipate the need for difficult airway equipment should our initial plan to secure the airway fail. We can all rest a little easier if we know that a video laryngoscope is nearby.

Once seen predominantly in large hospitals and teaching facilities, video laryngoscopes are finding their way into more and more ambulatory surgical facilities. When your pre-operative patient assessment indicates the likelihood of a difficult airway, intubating with a video laryngoscope has proved itself successful on the first pass. Some providers prefer to use a video laryngoscope for every intubation. Here's what to consider when buying a video laryngoscope.

• Ease of use. Seek a system that is easy and intuitive for your anesthesia staff to operate, keeping in mind how long it takes to assemble or start up for use. If your providers are using it primarily for difficult cases, they'll need it in a hurry when they reach for it. An in-service training session or routine practice may be warranted. Also, educate yourself and your ancillary staff on the proper cleaning and handling of the equipment to ensure that it's ready to go whenever it's needed.
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  Image quality. Invest in a system with a high-resolution digital camera to give your providers the best view possible of challenging anatomies. A high-quality, color, digital monitor will likewise display the fine details necessary for optimal guidance through the airway. Some monitors even have anti-glare screens to minimize the reflection of ambient light.
• Blade size. Choose a system that accommodates different sizes of laryngoscope blades, and be sure to stock several sizes of blades, in order to fit your facility's patient population. Blades are available in a range of sizes, from those designed to treat neonatal patients to those for the morbidly obese.
• Portability. The more portable the system, the better. There is little to gain from having to cart monitors, fiber-optic light sources and fiber-optic laryngoscopes around your facility when time is of the essence. Modern video laryngoscopes are small, lightweight, ergonomic and rugged enough that they can be carried in 1 hand and placed on a patient's bed if space is tight.
• Cost. While video laryngoscopes aren't inexpensive, their cost is extremely attractive in comparison to the cost of litigating a catastrophic event.

No matter how thorough our pre-anesthetic airway assessments may be, there are times when a patient's perfectly normal airway suddenly becomes problematic after induction. But as more and more facilities put video laryngoscope technology into the hands of their anesthesia providers, perhaps the "difficult airway" will become a thing of the past.

Airtraq
Airtraq Guided Video Intubation
(877) 624-7929
www.airtraq.com
List price: $79
FYI: A simple solution for video-guided endotracheal tube insertions, the Airtraq single-use optical laryngoscope is available in regular, small, pediatric and infant sizes. It is also available in variations designed for nasotracheal and endobronchial or double-lumened tube placements. The all-in-one device, which has a 3-year shelf life, is ready to go without assembly or connection to an external monitor. Its disposability lets facilities sidestep reprocessing and infection control concerns, while its portability, anatomical design and built-in anti-fog system provide ease of use in establishing an airway.

Clarus Medical
Clarus Video System
(800) 359-2372
www.clarus-medical.com
List price: $6,950
FYI: The Clarus Video System's digital stylet puts a high-definition camera at the end of the endotracheal tube, while the 4-inch LCD screen provides a wide-angle view of the larynx and video-output capability. An atraumatic tip ensures patient safety, while a white LED illuminates the airway without fogging. The malleable stylet, designed for access and maneuverability in difficult airways, detaches for reprocessing and reuse, and a rechargeable battery offers hours of use.

EZC Medical
Intubaid
(415) 867-9605
www.ezcmedical.com
List price: $79
FYI: EZC Medical's Intubaid is a single-use video stylet that fits within an endotracheal tube to provide instant feedback on the tube's placement. The device incorporates an integrated light source and a flexible tip that can be angled while inside the tube, for consistent visualization in most anatomies. The Intubaid's video feed can be displayed on any standard OR monitor or on the company's handheld, battery-operated monitor to enable a portable visualization system.

Karl Storz Endoscopy-America
C-MAC Video Laryngoscope
(800) 421-0837
www.ksea.com
List price: not disclosed
FYI: The C-MAC Video Laryngoscope's use of standard Macintosh blades means that there's not much of a learning curve for users. An additional D-blade's elliptical, tapered shape adapts to oropharyngeal anatomy for rapid and safe intubation of more difficult anterior airways, and the device accommodates size 0 and 1 Miller blades for neonatal intubations. A distally mounted CMOS chip provides at least 80 ? of view, and video and still images can be saved to a memory card.

LMA North America
McGrath Series 5 and Series 5 HLDi video laryngoscopes
(800) 788-7999
www.lmana.com
List price: Series 5, $14,995; Series 5 HLDi, $18,995
FYI: The McGrath Series 5 video laryngoscopes incorporate a small camera with a powerful light source at the distal end of the blade for a clear image of the vocal cords and surrounding anatomy and for efficient intubation guidance. A single AA battery powers a color video display, and the device requires no external cables. The Series 5 HLDi (High-Level Disinfection Immersible) has the additional advantage of being completely waterproof, letting its reusable components be effectively sterilized.

Olympus Surgical
Airway Mobilescope
(800) 548-5515
www.olympussurgical.com
List price: not disclosed
FYI: Olympus's Airway Mobilescope incorporates a 2.5-inch monitor, LED light source, battery and recording device in a single unit, all without peripherals or cables. Still images and video can be captured on a memory card. The device is available in 2 models with differing insertion tube and channel diameters.

Pentax Medical
AWS Airway Scope
(800) 262-8462
www.ambuusa.com
List price: not disclosed
FYI: Lightweight and ergonomically designed, the Pentax AWS (distributed by Ambu) features an adjustable monitor for intubation from multiple angles and a video-out port for connection to display monitors or recording devices. Its blade design puts less stress on the neck than conventional tools and has a separate opening for a suction catheter tube. It is compatible with endotracheal tubes with outer diameters of 8.5mm to 11mm and has a waterproof body for easy cleaning.

Verathon Medical
GlideScope Cobalt Advanced Video Laryngoscope
(800) 331-2313
www.glidescope.com
List price: not disclosed
FYI: The Glidescope Cobalt AVL combines a single-use stat (available in 5 sizes to handle a wide range of patient weights and sizes) and a reusable video baton (available in 2 sizes, with a high-resolution digital camera and anti-fogging mechanism) to provide a consistently clear, real-time view of the airway. The Cobalt features a digital color monitor, recording capability and an on-board video tutorial. Packed sterile, it is ready to use within seconds.