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tremendously when intubating," says Connie Casey, RN, CNOR, LHRM,
administrator of the Northpoint Surgery and Laser Center in West Palm
Beach, Fla. "You can see clearly with the scope when you can barely
open the mouth."
Providers might try to intubate with a direct laryngoscope before realizing it's much more difficult than they imagined. Instead of making a second attempt with a different direct blade or other technique, they can
simply grab a video laryngoscope in the room or ventilate for another 30
seconds until a technician retrieves the device from storage.
"While not needed in most cases, the video laryngoscope has bailed me out
of difficulty a great many times," says Dr. Doyle. He believes you should
always have one readily available when routine intubations turn out to be anything but, although that doesn't mean you should always use it. Dr. Doyle
works at a teaching institution, and understands the importance of keeping
direct laryngoscopy skills sharp for routine cases.
Todd Stevens, MD, agrees. "I think traditional rigid laryngoscopes will
remain the standard for routine intubations," he says. "However, I do
believe that video laryngoscopes have become the de facto backup standard in the event of an anticipated or unanticipated difficult intubation."
When he began as the medical director for anesthesia at the Advanced
Orthopaedics Surgery Suite in Richmond, Va., video laryngoscopes
became mandatory in airway carts. "They're a huge safety net if you're
having difficulty with traditional instruments or you're concerned you
might be dealing with a difficult airway," he explains. "They're our standard of practice."
Many of today's patients are sicker, heavier and presenting with more
comorbidities than ever, so "having more tools available makes me feel
comfortable tackling different anatomy, especially in patients with more
anterior laryngeal positions and soft tissue around their airways," says Dr.
Stevens. "Every device at your disposal increases successful airway man-
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O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | O C T O B E R 2013
