• Daniel R Chang, Garrett W Burnett, Sophia Chiu, Yuxia Ouyang, Hung-Mo Lin, and Jaime B Hyman.
• Department of Anesthesiology, Perioperative and Pain medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1010, New York, NY 10029, United States. Electronic address: Daniel.chang@mountsinai.org.
• J Clin Anesth. 2023 Oct 1; 89: 111187111187.

Study ObjectiveIncreased regulatory requirements for sterilization in recent years have prompted a widespread transition from reusable to single-use laryngoscopes. The purpose of this study was to determine if the transition from metallic reusable to metallic single-use laryngoscopes impacted the performance of direct laryngoscopy at an academic medical center.DesignSingle-site retrospective cohort study.SettingGeneral anesthetic cases requiring tracheal intubation.PatientsAdult patients undergoing non-emergent procedures.InterventionsData were collected two years before and two years after a transition from metallic reusable to metallic single-use laryngoscopes.MeasurementsThe primary outcome was need for intubation rescue with an alternate device. Secondary outcomes were difficult laryngeal view (modified Cormack-Lehane grade ≥ 2b) and hypoxemia (SpO2 < 90% for >30 s) during direct laryngoscopy intubations. Subgroup analyses for rapid sequence induction, Macintosh blades, Miller blades, and patients with difficult airway risk factors (Obstructive Sleep Apnea, Mallampati ≥3, Body Mass Index >30 kg/m2) were performed.Main ResultsIn total, 72,672 patients were included: 35,549 (48.9%) in the reusable laryngoscope cohort and 37,123 (51.1%) in the single-use laryngoscope cohort. Compared with reusable laryngoscopes, single-use laryngoscopes were associated with fewer rescue intubations with an alternate device (covariates-adjusted odds ratio [OR] 0.81 95% CI 0.66-0.99). Single-use laryngoscopes were also associated with lower odds of difficult laryngeal view (OR 0.86; 95% CI 0.80-0.93). Single use laryngoscopes were not associated with hypoxemia during the intubation attempt (OR 1.03; 95% CI 0.88-1.20). Similar results were observed for subgroup analyses including rapid sequence induction, Macintosh blades, Miller blades, and patients with difficult airway risk factors.ConclusionsMetallic single-use laryngoscopes were associated with less need for rescue intubation with alternate devices and lower incidence of poor laryngeal view compared to reusable metallic laryngoscopes.Copyright © 2023 Elsevier Inc. All rights reserved.

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