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agement, service to your patients and patient safety."
The importance of intubating even difficult airways quickly and with relative ease isn't lost on those outside the OR. "When the technology
improves the success rate of first-attempt intubation, it saves us time,
which in turn saves us money," says Kari Stewart, BBA, BFA, CASC, the
administrator of the Pasadena (Calif.) Plastic Surgery Center.
Can you push the envelope?
As a general rule, says Dr. Doyle, you should make 3 attempts at placing
the endotracheal tube. If they prove unsuccessful, wisdom dictates you
wake up the patient and proceed with fiber-optic intubation.
"Many times I'd get called to the OR when a patient couldn't be intubated,
slide in a video laryngoscope, get a really good view of the glottis and put
the tube in without difficulty," he says. "That avoided having to proceed with
awake intubation or canceling the case altogether." But should video laryngoscopes give providers more confidence in managing the airways of highacuity patients in the outpatient setting? "That's one of the big debates
among anesthesia providers," says Dr. Doyle.
Not long ago, he says, no one in day surgery centers would operate on
patients with BMIs over 35. Now many providers argue that intubating
those individuals has become easier because of improved airway technologies such as video laryngoscopes.
Dr. Doyle believes assessing how easy or difficult it is to intubate highacuity individuals oversimplifies a complex issue. "After you extubate
these patients," he explains, "many of whom have sleep apnea, questions
remain about how long they should be monitored post-operatively in
ambulatory settings."
User-friendly features
Compared to other techniques such as fiber-optic visualization, "the prop-
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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
