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of patients with short necks, large breasts or halo traction. A device
that offers an assortment of blades — different sizes, types and
degrees of curve — will be more adaptable to more anatomical situa-
tions, whether that means adults, obese adults or children.
While many video laryngoscopes have a shallow learning curve,
don't take the increased safety they deliver for granted. "Make sure
everyone managing airways is trained and checked off on the device,
so they will know the right way and wrong way to use it," says Mr.
Cryder.
In fact, the need for training is a compelling argument for routine-
ly using video laryngoscopes in uncomplicated cases. You can't
expect a rapid-response backup plan to succeed if it hasn't been
thoroughly practiced.
"The single most important thing is to use these devices to get
good," says D. John Doyle, MD, PhD, a professor of anesthesia at
the Cleveland Clinic in Ohio. "If you only use them for emergencies,
you're not going to be very slick with them." Use them in normal
anatomy to develop and maintain competency, he suggests. Practice
makes the purchase pay off.
2. Image and output
With video laryngoscopes, the quality of the image is an important
consideration. Image quality differs from device to device, and
depends on the camera's position and resolution, the system's reliabil-
ity and the laryngoscope's screen, among other factors.
For instance, what sort of image does a device's camera show you?
The highest-quality laryngoscopes, says Mr. Cryder, show a wide area
of the oropharynx since the camera doesn't sit right on top of the glot-
tic opening. "It's the difference between looking at your finger while
holding it 2 inches away from your eyes, or holding it 12 inches away,"
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