VOLUME 32, ISSUE 1

John S. Kenney, MD

 

John S. Kenney, MD, FASA

Chief of Anesthesiology
Baylor Scott & White Medical Center College Station
College Station, TX

Is It Time to Reconsider Disposable Laryngoscopes?

 

The laryngoscope is one of many tools anesthesiologists routinely use in their practice. The laryngoscope handle and blade are important components in every anesthesiologist's repertoire of safely securing a patient's airway, yet, it is not something that many of us dwell upon often. If the batteries and light appear to be working adequately and meet our criteria to allow us to perform a safe and a traumatic intubation, we rarely give the laryngoscope deeper scrutiny.

The standard reusable laryngoscopes must undergo a sterilization and packaging process and, depending on each facility's cleaning policies, the amount of time they are out of service due to sterile processing is not insignificant. In addition, the cleaning process potentially exposes the light source to damage. There are also the costs associated with the sterile processing personnel, the cleaning equipment and different solutions used in the cleaning process. One common processing workflow consists of initial debulking by manual washing and scrubbing the laryngoscope blades followed by an ultrasonic bath in an enzymatic solution, a separate timed machine wash that contains an enzyme agent and a soap. After drying in a warmer the laryngoscope blade is then processed through a low temperature sterilization process. Once the blade is dry, it is packaged with an indicator strip to show the cleaning was successful. In addition to the apportioned costs of processing, there is the cost of having an ample number of duplicate laryngoscopes available for use during the turnaround time.

Recently, high quality disposable laryngoscope blades and handles have become much more affordable. Disposable laryngoscopes have an associated cost per use which must be compared to the sterile processing costs associated with the reusable laryngoscopes. The financial component of a one-time use piece of equipment versus the longevity of a reusable laryngoscope has to be evaluated to determine its feasibility for each facility.

Many companies are now manufacturing affordable high quality single use laryngoscope blades and handles. Vendors tout their products as cheaper than the reusable alternatives when cleaning costs and personnel are factored into the equation. In the past, the functionality of disposable laryngoscopes was a concern due to potentially serious issues. Recurring problems ranged from the blade becoming unhinged from the handle at critical times during an intubation, varying light source quality and intensity, and the potential for breakage under stress. The above reasons, combined with prohibitive costs, caused many anesthesiologists to discount disposable laryngoscope tools as a viable option for routine use. Advances in quality and price point reductions have led many to reconsider this issue.

Several companies now offer high quality disposable laryngoscopes. The light source is typically an LED fiber optic source, similar to most standard reusable laryngoscopes. When comparing a new, reusable light source with a disposable light source, the lumens are similar but the disposable laryngoscope offers the advantage of a new light source with each use. Standard laryngoscope light sources can suffer damage to the light fibers over time with use and handling. At our hospital we passively rolled out the disposable laryngoscopes by making the disposables available if an anesthesiologist or nurse anesthetist wanted to try one. One of the most common comments received in feedback was how pleased users were with the light intensity. Several commented that they did not realize how dim the light intensity of the reusables had become over time. This reinforced the need to have the light sources on reusables included as part of a preventative maintenance program, which is an additional cost for the standard laryngoscope equipment. Additionally, the shelf-life of the single use laryngoscopy tools appears to be exceptional. As a one-time test of the light source, we left a disposable laryngoscope handle and blade open with the light source engaged for several days. The light source lasted about eight days before there was appreciable decline in the light intensity.

The disposable laryngoscopes have a wide assortment of blade profiles to choose from, as do the reusables, and these blades appear to be durable and without the issues of earlier versions. There are the common handle styles available regular, stubby and minis and the handles have a rubber grip that allow a secure grip. The most common negative feedback we received was that the plastic blades tend to slip when pressed against the tongue in patients with excessive secretions.

One of the most commonly voiced concerns associated with the disposable products is the contribution each disposable laryngoscope contributes to our landfill burden. Single use medical products contribute a significant amount of waste to our landfills and this transition would only further that problem. The single use laryngoscopy tools are high quality plastics and rubber and that translates into a large amount of slowly degrading components being added to our landfills. Additionally, each handle contains alkaline batteries. In 1997 the U.S. government mandated the removal of mercury from alkaline battery manufacturing and this cleared the way for making it permissible for them to be disposed of in general landfills. The handles are sealed which makes battery retrieval for recycling difficult and alkaline battery recycling is not as prevalent as it for rechargeable batteries. The landfill is about the only option for alkaline batteries because they cannot be incinerated due to the explosion potential of the potassium hydroxide. They do contain small amounts of steel, zinc and manganese but these are difficult to extract for recycling.

Overall, disposable laryngoscopes have performed favorably. In addition to their routine use in operating rooms, they may be ideal for uses outside of the standard operating room area. Their use in contaminated cases may be efficient when the logistics of getting the reusable laryngoscope to the sterile processing area is challenging. Another consideration for use is during after-hours and weekends when sterile processing personnel is limited or unavailable.

It is challenging to make a direct cost comparison for the cleaning and maintenance of the standard equipment versus the single use products. Many of the costs of personnel and cleaning equipment are fixed costs and should not be fully factored into the cost of cleaning and maintenance. However, as the quality of these products increase and the price points decrease, we must all examine our processes and weigh the pros and cons of incorporating these products into our practice.

 

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