If you're in the market for a video laryngoscope, there's no substitute for test driving these advanced airway management devices in real cases, on real patients. A little product research goes a long way, too. Here are 6 purchasing considerations, followed by 12 product summaries on pages 66 to 71.

Ease of use
Video laryngoscopes in no way replace the skill and training necessary to facilitate tracheal intubation, but they've changed the way we approach a wide variety of challenging patients. While a device's ease of use depends in large part on a practitioner's level of experience, some devices offer more straightforward operation than others. The blade's size and shape can be prohibitive in patients with limited oral anatomies. Increased manipulation and force could injure oropharyngeal structures, affect the integrity of the endotracheal tube and/or cuff, and hinder the likelihood of first-pass success in intubation. Each of the devices available today provide fiber-optic verification of tracheal intubation, but training is essential.

Screen size
Size matters! More pixilation equals a higher image resolution and a clearer view. Smaller screens on ultra-portable handheld devices can impair picture clarity and, as a result, a provider's confidence in attaining proper endotracheal tube placement. Several devices offer integration with existing video imaging hardware and monitors that may already be installed in your ORs. This can be a big selling point and advantage to visualization if the airway device will be used in those rooms.

Portability
Where will your anesthesia providers use the video laryngoscope? A device whose compact size and easy assembly lends itself to enhanced portability can serve the needs of many care settings. But this may subject the instrument — some models of which can cost as much as a flexible endoscope — to loss, misplacement or damage.

Cost
One big question is, how much of a role will video laryngoscopy play in your facility? Is it going to be used as an emergency backup when attempts at traditional intubation methods have failed? Or are your anesthesia providers planning to use fiber-optic visualization for all airways? Single-use devices are becoming much more popular, offering the dual advantages of preventing cross contamination and eliminating the need to reprocess them, but their costs may escalate with frequent use.

Patient demographics
Some devices offer a complete range of options for airway visualization, serving pediatric to adult to obese adult patients. Other manufacturers offer a limited size range. Anticipating future needs is an important step in selecting the appropriate video laryngoscope. Choose a device based on your patient population's demographics as well as the anticipated use of the instrument. Practice patterns and facility utilization evolve over time, and the capability to conduct video laryngoscopy among pediatric patients, for example, may be as easy as changing a disposable handle, or may require the purchase of an altogether different system.

Recording capability
Some facilities may have a greater exposure to teaching (such as the education of residents, students, community emergency medical service providers or others). They may review untoward anesthetic events rigorously. For these facilities, the ability for providers to digitally record an entire intubation sequence and save it as a memory file on the video laryngoscope for download and later analysis may prove extremely advantageous.

Airtraq
Airtraq Avant
www.airtraq.com
(877) 624-7929
Pricing: Disposable blades, $5.90 each. Reusable optics, $350 for 50 uses.
FYI: The Airtraq Avant video laryngoscope consists of reusable optics completely enclosed in a disposable blade for a low-cost, no-cross-contamination device. The optics, which contain the electronics and are good for 50 uses, slide into the anatomically designed, rigid plastic blade and are switched on. After use, the blade is discarded and the optics are plugged into the docking station, which recharges the battery and shows the remaining life. At $12.90 per use, the company notes, the Avant makes video-guided laryngoscopy a cost-efficient option for daily as well as difficult intubations.

Clarus Medical
Clarus Video Stylet
www.clarus-medical.com
(800) 359-2372
Pricing: $7,295; additional stylets, $2,790
FYI: Why guide your tube blindly, Clarus asks, when you can add video to every intubation? The company's video system is a portable, malleable video stylet with a camera and LED at the tip. The view lets users steer an endotracheal tube to exact placement in difficult and routine airways. The device can be used independently or as an adjunct to direct laryngoscopy, video laryngoscopy or supraglottics for anterior airways, small mouths or awake intubations. It even includes a red LED for transillumination and accommodates an optional longer stylet for double-lumen tubes.

Covidien
McGrath MAC Video Laryngoscope
www.covidien.com/rms
(800) 635-5267
Pricing: Handle, $2,500; blades, $12 each
FYI: Covidien's McGrath MAC enhanced direct laryngoscope combines the familiarity of direct visualization and a Macintosh blade with the advantages of image-guided technology. Its anterior camera reduces the "tunnel vision" encountered with conventional, direct-view-only laryngoscopes to improve views for rapid, seamless tube placement. This can aid in managing difficult airways and also in avoiding the blind, misplaced and delayed intubations that can slow down everyday practice. Slim-line blades provide greater maneuverability in small mouth openings to prevent dental interactions during intubation. Physicians can benefit from the advantages of enhanced direct laryngoscopy with no additional training in their conventional techniques.

Dispososcope US
The Dispososcope
www.disposcope.us
(732) 666-8875
Pricing: $2,800 to $3,600
FYI: The Dispososcope provides the functionality and advantages of 4 tools — a laryngoscope, a lighted stylet, a video-assisted scope and a fiber-optic scope — all in 1 lightweight, portable device. The battery-operated handset's light, video camera and full-color LCD display are used together to guide intubation. The camera at the tip is positioned inside the endotracheal tube for unobstructed placement. Its flexibility, wireless technology and auto-focusing camera make it easy to operate single-handedly. The result is intubation without risk of injury to the patient's anatomy or ergonomic stress on the user.

Karl Storz Endoscopy
C-MAC Video Laryngoscope System
www.karlstorz.com
(800) 421-0837
Pricing: $10,000 to $25,000, depending on components
FYI: Karl Storz's C-MAC Video Laryngoscope System is designed for portability. Its use of standard-shaped Macintosh blades in sizes 2, 3 and 4 flattens the learning curve for physicians. It also accommodates the elliptical, tapered D-blade to handle the intubations of more difficult anterior airways, as well as Miller size 0 and 1 blades to adapt to the oropharyngeal anatomies of pediatric and neonatal patients. Distal CMOS chip ("chip on the tip") technology improves image quality and enables a wide field of view, and still images can be captured and stored on a memory card.

King Systems
King Vision Video Laryngoscope
www.kingsystems.com
(800) 642-5464
Pricing: Reusable display, $999; disposable blades, $299.50 for 10; King Vision kit (reusable display, standard disposable blade and 3 channeled disposable blades), $1,099
FYI: The King Vision is an affordable, durable, portable video laryngoscope, designed for indirect laryngoscopy and difficult as well as routine endotracheal intubations. Its standard blade accommodates minimum mouth openings of 13mm and its channeled blade 18mm, making it effective for most adult patients. The full-color, glare-free display can weather normal wear and tear and repeated cleaning, while the camera and light source are enclosed in the disposable blade, protecting the fragile optics. Lightweight, self-contained and battery-operated, the King Vision display is packaged in a protective foam case and is water-resistant when assembled.

Teleflex
McGrath Video Laryngoscope
www.lmana.com
(866) 246-6990
Pricing: $7,500 to $10,000
FYI: Portable, durable and lightweight, the McGrath Video Laryngoscope from LMA (a division of Teleflex) is designed to sit balanced in users' hands, enabling real-time views of the airway for simpler, less traumatic intubations with little or no changes in users' laryngoscopic technique. No focusing or image adjustment is needed: An on-off switch is the complete user interface to the small camera and light source at the distal end of the single-use blade, and the high-resolution color display. The device includes no external cables and operates on 1 AA battery.

Magaw Medical
CoPilot VL
www.copilotvl.com
(855) 267-4568
Pricing: Starter kit (scope and 3 boxes of disposables), $2,999
FYI: Developed by a pair of CRNAs who believe that video laryngoscopy should be the standard of care for every patient and in every case, the CoPilot VL respects the natural curve of the oropharynx with an angulated blade that eliminates the need to lift, move and straighten a patient's airway anatomy to intubate. The device's patent-pending Bougie Port, a C-shaped channel built into the side of the disposable sheath, enables easier maneuvering of the endotracheal tube through the glottis into the trachea for proper placement. A rechargeable battery offers 2 hours of continuous use.

Medical Products International
MultiView Scope
www.mpi-inc.co.jp/eng
(866) 230-9451
Pricing: $3,900 to $14,100, depending on components and accessories
FYI: MPI's MultiView Scope is a portable system that incorporates a single handpiece with an integrated monitor and accommodates multiple attachments for video-assisted intubation on patients ranging from infants to adults. The similarity of its blades to those of traditional laryngoscopes virtually eliminates the learning curve for the user, and the device's ability to conduct both direct and video visualization make it ideal for routine use as well as training. A stylet attachment can assist in difficult intubations and anatomies with limited oral access. The video signal can be routed to external monitors for viewing and recording.

Olympus America
MAF Airway Mobilescope
www.olympusamerica.com
(800) 848-9024
Pricing: not disclosed
FYI: Olympus's MAF Airway Mobilescope is a portable, flexible intubation endoscope with expanded viewing and recording capabilities. Its standalone design incorporates a monitor, LED light source, battery and recording device in a single unit, offering the mobility to handle difficult intubations in any clinical setting without the need to connect to external cameras, monitors or procedure carts. The MAF is available in 2 versions: Type GM has a small insertion tube suitable for intubation, while Type TM is equipped with a larger channel that supports suction, bronchial lavage and instrument use.

Truphatek
Truview PCD-R
www.truphatek.com
(573) 657-0907
Pricing: $975 to $6,500, depending on options
FYI: The Truview PCD-R's options allow each user to customize his system's complexity. Low-profile, narrow-tip, optical blades are available in sizes 0 to 4 (for pre-natal to obese adult patients), each integrated with an oxygen-jet cleaning system to clear misting and mucus accumulation. Two sizes of soft-feel, ergonomically designed, rechargeable, LED-illuminating handles are available. Images can be viewed on the portable, 5.5-inch, still and video recording monitor or by quickly connecting to most endoscopic HD cameras and monitors. Plus, the blades and handles can also be used independently for conventional, direct laryngoscopy.

Verathon
GlideScope AVL Video Laryngoscope
www.verathon.com
(800) 331-2313
Pricing: not disclosed
FYI: With innovative blade sizing, angulation and camera positioning, Verathon's GlideScope AVL Video Laryngoscope is designed to provide consistently clear airway views and enable quick intubations. Its proprietary Reveal anti-fog function, featuring a rapid heating profile, resists lens clouding and secretions. The system offers a choice of reusable or single-use blade configurations for patients ranging from pre-term to morbidly obese. Its real-time recording and animated, onboard tutorial also facilitates user training.