Video laryngoscopy is poised to replace conventional laryngoscopy as the intubation method of choice. It consistently lets you visualize intubation, something direct laryngoscopy often fails to do. It also improves our clinical documentation with video records.

Stored videos of intubations aren't just useful to subsequent care providers who can use them to see in advance what kinds of difficulties they might encounter. They're also useful to practitioners who want to improve their techniques. Laryngoscopy is so task-focused that we often don't recognize how much we can improve by better understanding how certain difficulties might have been circumvented.

Here are a few considerations to keep in mind if you're shopping for a video laryngoscope.

Familiarity may breed contempt. The video laryngoscope that seems most familiar, or most compatible with your experience in direct laryngoscopy, isn't necessarily going to be the best choice. If you're not experienced with video laryngoscopy, the best choice depends in part on your willingness to learn new techniques. Some video scopes are shaped differently than conventional laryngoscopes. Hyper-angulated blades enable viewing that might not otherwise be possible, but they require a somewhat different technique than conventional Macintosh blades. If you're not prepared to learn the differences, you may end up frustrated, because the scope isn't providing a dramatic improvement over direct laryngoscopy.

Take the time to train. Your anesthesia providers will need proper training when they begin using video laryngoscopes. Being an experienced direct laryngoscopist doesn't necessarily confer expertise when using a video scope.

How well can you see the larynx? High-quality video is nice to have, but I think it's a secondary concern. The key is to be able to see the larynx clearly enough to intubate. If you're doing a diagnostic laryngoscopy, you need a high-resolution image; but if you're attempting to intubate, which is likely to be what you'll most often use the scope for, good laryngeal exposure is more important than image quality. There is, however, an advantage to having a larger screen. The more people in the OR who can see the screen, the greater the potential for valuable support.

Blade sizes. If you're handling neonatal, obstetrical and pediatric patients, as well as adults of all dimensions, you'll either need a scope that can handle an appropriately wide range of sizes — which not all scopes can — or multiple scopes that may differ in the ways they're used. In an emergency, you don't want to have to use a scope that requires a technique you're less familiar with.

Channel challenge. Would you prefer a channeled device or a non-channeled device? Channeled devices may be easier to master, but they're also bulkier, because the endotracheal tube is incorporated into the blade. Non-channeled devices let you manipulate the endotracheal tube and the laryngoscope independently of each other. But they also require better hand-eye coordination.

Reusable or disposable? Should you opt for a single-use device, a reusable device or something in between? The question hinges on how often you'll use a video laryngoscope. Single-use devices may be relatively inexpensive, but if you use them frequently — which, as noted, I think you should — the cost may rival or exceed that of a reusable scope, or one with reusable components. Plus, your reusable scope may actually last several years.

On the other hand, reprocessing a reusable scope takes time — 3 or 4 hours, when you follow manufacturer recommendations. So if cost dictates that you're going to be able to stock only a few scopes, it might be wise to consider single-use devices. Even if you're using them only as rescue devices, you don't want to find yourself needing your reusable scope before it's fully reprocessed. If turnaround time is an issue, the ideal solution may be to stock both types. That way you never end up unable to call on one for a needed rescue. OSM

Ambu
King Vision aBlade
ambuusa.com
(800) 262-8462
Price: $1,399
FYI: The King Vision aBlade video adapter is reusable and comes with individually packaged disposable blades. Designed to be light, self-contained and battery-operated, it can be used continuously for about 80 minutes. It comes with both a standard blade, which requires a stylet to direct the endotracheal tube and a 13-mm mouth opening, and a channeled blade, which allows the endotracheal tube to be guided and requires an 18-mm mouth opening. The full-color, non-glare display can resist repeated cleanings, says the company, and it's compatible with external monitors and recording devices.

Karl Storz
C-MAC S
karlstorz.com
(800) 421-0837
Price: not disclosed
FYI: The C-MAC S video laryngoscope is a standalone system designed for single use. The blade and handle form one continuous piece to help guard against infections, and the C-MAC S imager component, once removed from the handle, can be reprocessed at temperatures up to 65 ?C. Available adult blades include the Karl Storz D-Blade for difficult airways, and Macintosh 3 and 4 blades, as well as Miller 1 and 0 blades for pediatric and neonate use.

Magaw
CoPilot VL
copilotvl.com
(855) 267-4568
Price: not disclosed
FYI: The CoPilot VL, with its C-shaped channel, can accommodate a stylet, but also has a patented bougie port that's designed to help when the view is good, but the tube won't seem to "go around the corner." Its external display can be mounted to an IV pole or propped up with a built-in stand. A rechargeable battery provides two hours of continuous use, and an anti-fog mechanism keeps visualization clear.

Teleflex
Rusch Airtraq Avant Video Laryngoscope System
teleflex.com/laryngoscopes
(866) 246-6990
Price: not disclosed
FYI:: The Rusch Airtraq Avant Video Laryngoscope System has a rotating screen to help facilitate intubation from any position. Along with providing a direct view, it allows a shared view that can be projected wirelessly via WiFi to cameras and mobile devices. The optics can be used up to 50 times, but the blades are single-use and designed to fully isolate the optics from patient contact. Assembly is quick and intuitive, says the company, making it ideal for time-critical situations.

UE Medical
VL400 Video Laryngoscope System
uescope.com
(617) 610-2718
Price: starting at $2,500
FYI: Compact, cordless and lightweight, the VL400 series features more than 10 interchangeable components, so it can be used with reusable blades, disposable blades or video stylets. The camera is angled to provide optimal exposure of the larynx, and the monitor can be tilted and turned, making it possible to intubate from the front of the patient. It runs on a rechargeable lithium-ion battery, and an optional recording function can save both still images and videos.

Verathon
GlideScope Spectrum Single-Use
glidescope.com
(800) 331-2313
Price: not disclosed
FYI: Verathon's newest video laryngoscopes feature light-control and ambient-light-reduction functions that are designed to optimize image brightness at the vocal cords and reduce nonessential light. Disposable blades provide a larger viewing channel than previous GlideScope Mac-style blades, which improves direct views for teaching and using direct laryngoscopy technique, says the company. The new blades, which come in 6 sizes ranging from neonate to large adults, are also 30% wider, to help improve tongue control during intubation.