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question: Should you use video laryngoscopes for all intubations, or just reserve it for difficult ones? Some anesthesia providers would argue no, that while video laryngo- scopes are a nice tool to have, they often have a better view with a stan- dard Miller blade, its straight blade directly lifting up the epiglottis and pro- viding a clear view of the glottic opening. They might also argue that their intubation skills will atrophy if they rely solely on video laryngoscopy. What if they're in the cath lab, MRI lab or some other off-site location that doesn't have a video scope and there's an airway emergency? They'll be in a world of trouble if they need to do an emergency intubation. Let me address that last point first. True, video laryngoscopy is easier to learn and perform, but performing direct and video laryngoscopy is similar in style and technique. The only difference is you're looking at amazing anatomic views on a video screen, not crouching and using one eye to look down someone's mouth to align the oral–pharyngeal– laryngeal airway axes for an optimal view of the glottis. With a camera at the end of the blade, as close as possible to where you're trying to get to, video laryngoscopes give you the best view you can possibly get. I'm not sure how anyone could argue that the view is better with direct laryngoscopy. Video scopes provide a better view of the anatomy and of the endotracheal tube passing through the vocal cords, making the pro- cedure safer for the patient. Backup no more Video laryngoscopes were traditionally used as a backup to standard direct laryngoscopy blades. And it's true that you can intubate 90% of your patients with a standard blade. But here's the main reason to use them on every patient: It's impossible to predict a difficult intubation. Things might seem routine before the patient goes to sleep, but then you encounter a big tongue, a stiff neck, loose teeth or a narrow 1 0 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • S E P T E M B E R 2 0 1 6