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a [portable video laryngoscope] has sure made my practice easier,"
says Melinda Miller, CRNA, DNP, in Waxahachie, Texas.
"Unless there is an obvious very difficult airway, especially from a
tumor or other mass effect around the airway, we do not say no to
'routine' difficult airway patients at our ASCs," says a Cleveland anes-
thesiologist, adding that "video intubation devices have made handling
most difficult airway patients into a much more routine procedure."
But improved technology doesn't justify making that leap, others
argue, pointing out that with any device, help may be needed, and it's
likely to be harder to find in outpatient settings.
"By the very definition of a surgery center there are often less
resources available, including another set of educated anesthesia
hands," says Mike MacKinnon, CRNA, a partner in a CRNA-only prac-
tice in Arizona. "Often, all providers are in their own rooms and cannot
assist each other, whereas at a hospital there's always someone around
in the lounge between cases. Even as we gain better technology, we
should be very careful not to assume that means we can do difficult-
airway patients in ASCs."
Video tops the list
While some still hesitate to change their protocols, more than three-
fourths of our 49 panelists say improvements in airway management
will gradually broaden the range of patients who can be treated in
outpatient facilities. Video laryngoscopes are far and away the most
frequently cited improvement, having "made an enormous impact on
managing suspected difficult airways," as Anthony P. Randazzo III,
MD, an anesthesiologist in Brick, N.J., puts it
There's no question that video scopes in trained hands literally pro-
vide a picture and a straight shot to the glottis, eliminating the need to
look around corners or move anatomy. But does that justify relaxing
