laryngoscopes have improved so much that, "with a little bit of train-
ing, you can turn everybody into someone who can successfully intu-
bate 90% of the American public," says Tom Losasso, MD, staff anes-
thesiologist with Summit Anesthesia/Orthopedics in Eagan, Minn.
"Every [outpatient facility] should have a video laryngoscope because
it makes everybody more effective."
Emerging disposable video laryngoscopes could make economic
sense for smaller facilities as opposed to buying a single reusable
scope that costs thousands of dollars and requires maintenance and
cleaning, says Dr. Berkow, while larger facilities with dozens of ORs
may be better served buying multiple $15,000 reusable scopes rather
than hundreds of disposable ones.
Supplemental oxygen devices
Supplemental oxygen devices are gaining favor in response to treating
older, heavier patients with several comorbidities.
"You can be really facile with a video laryngoscope," says Dr.
Berkow. "but if your patient starts to desaturate the minute you give
sedation, you also need a plan to oxygenate and ventilate."
One such plan uses a device that delivers humidified nasal oxygen
at up to 30 liters a minute that's "surprisingly well-tolerated by
patients," says Dr. Berkow, adding it's proven effective on patients
with some airway stenosis or ENT lesions.
Another is a CPAP-like device that fits over the nose and hooks up
to high-flow oxygen. "It stents the airway open, so they're really valu-
able for patients with morbid obesity or obstructive sleep apnea," says
Dr. Berkow. "You can put these devices on before they go to sleep and
leave them on during airway management, because they're delivered
through the nose."
High-flow nasal oxygen could let your providers sedate more
patients with an uncontrolled airway rather than intubating or placing
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