By Pete Mercer
Airway management is a significant source of anxiety for anesthesiologists working in an ambulatory surgery center. Finding ways to reduce that anxiety is critical for the mental well-being and productivity of practitioners in these facilities. In a recent episode of the Medtronic ASC Insights podcast, host Saul Marquez spoke to Dr. Adam Thaler, Medical Director at Summit Health, about the value of using video laryngoscopy to improve airway management protocols in ambulatory surgery centers.
The difference between direct and video laryngoscopy
Part of the challenge in today’s market is making the decision between direct laryngoscopy or video laryngoscopy; while both approaches might work, it’s important to look at the benefits of using video laryngoscopy to improve patient safety.1 Due to the development of video laryngoscopy, Dr. Thaler argues that intubation is much more accessible to clinicians than it was 10 to 15 years ago.
“I had an older colleague ask how to decide if they want a direct laryngoscope or video laryngoscope. Every facility can have a video laryngoscope now. It’s commonplace, economical, and it makes sense. But what if your team needs to learn anatomy? You learn more by having an attending watch with a video camera of what they’re seeing with the arytenoids, vocal cords, and the epiglottis – they can learn from everything they’re seeing.”
Essentially, the first attempt at intubation should be the very best attempt.1 Anything other than that is likely to increase airway management challenges during the procedure, threatening the health and safety of the patient. With a video laryngoscope, clinicians can create active learning opportunities for their less experienced colleagues.1
When looking for a video laryngoscopy solution, Dr. Thaler needed something that was easy to use, improved clinical outcomes with peer-reviewed data,1 economically viable,1,2 portable, and reliable. This tool needed to be immediately accessible for less experienced practitioners,1 while relieving any anxiety over airway management for everyone in the facility.
Making the right decision
Because of the high patient turnover rate, the ASC setting requires clinicians to be quick on their feet. A key part of efficiency in these scenarios is leading with the right decisions about the right tools – it needs to fit the workflow and the needs of the clinicians that are using it.
Airway management is a critical part of the surgical process, ensuring that patients have an open and protected pathway for oxygen to enter the lungs and carbon dioxide to leave the body. Getting this right is crucial to improving patient outcomes. This is especially important in ASCs because they don’t have the same resources as a hospital – there’s no safety net or backup team for support when something goes wrong.
Every time a patient goes under anesthesia for surgery, there’s a risk of failure. After witnessing a failed intubation at his previous job in a hospital setting, Dr. Thaler learned about the dangers of inadequate airway management. While the patient survived, it resulted in a complicated and costly ICU stay.3 He found that the entire situation could have been avoided by using video laryngoscopy.
He said, “If I’m not able to be successful, then unfortunately, the patient is not going to do well.”
Because of that experience, Dr. Thaler made video laryngoscopy one of his requirements for working with patients once he started working at Summit Health. His mandate required that every OR at Summit Health was equipped with video laryngoscopy and that every procedure used it for airway management.
“It was a requirement, not an ask or a want. It was a need that I would have a video laryngoscope, and the one that I preferred was the McGRATH MAC,” Dr. Thaler said.
The McGRATH MAC
Dr. Thaler uses the McGRATH MAC video laryngoscope, because he needed something that was economical2 and safe1 for his ASC.
The McGRATH MAC video laryngoscope is a portable, affordable,1 and ergonomic device that is designed with the clinician and the patient in mind. It improves first-pass intubation success rates for both experienced and inexperienced clinicians1, reduces the overall intubation times,4 and lessens negative complications from failed intubations.1
Not only can the clinicians count on a smoother intubation process with video laryngoscopy, but surgeries can also start sooner because the process is faster.5 If you have a patient on the table and the clinical team is having trouble intubating, it wastes valuable time and resources that some ASCs just don’t have. If the facility is going to be productive, the team needs to invest in a tool like the McGRATH MAC, according to Dr. Thaler
Dr. Thaler found that the McGRATH MAC has a lower overall cost compared to some of the other video laryngoscopes2 on the market as well as lower costs than disposable direct laryngoscope blades when factoring in the entire cost structure.1 Additionally, incorporating video laryngoscopy into the surgical process creates indirect cost savings opportunities by streamlining and simplifying the intubation protocols1 – when the clinical team is intubating correctly the first time,1 there are much fewer mistakes across the board.
Designed for the needs of an ASC
Due to the size of the facilities and the number of patients that come through the door, ASCs have to be fairly lean and conservative with the decisions they make.
“I want to make sure that I have the best chance for success,” Dr. Thaler said. “It needs to be the best for my patients. It’s going to keep them safe and limit complications. So, for every intubation, we use a McGRATH MAC.”
Dr. Thaler’s time carrying the device on call around Summit Health helped to eliminate his airway anxiety by working consistently with each new intubated patient.
One of the biggest deciding factors for Dr. Thaler came when he learned that patients who were VIP got the “special treatment” of video laryngoscopy for surgical procedures, in order to avoid damaging their teeth or injuring their lips. They got the best treatment because they were considered more important than other patients.
That didn’t’ sit well with Dr. Thaler, who then decided to incorporate the McGRATH MAC because it would improve the equity of care across his ASC. He wasn’t going to treat any patients better than others, so he picked the tool that can help him do that.
“Why wouldn’t you treat everyone that way? I want to treat all my patients the way that I want to be treated, the way that VIP is treated. I give all my patients the same care as if they were a family member.”
For trained personnel only. For specific indications and instructions for use, please refer to the product manual.
References
1. Kriege M, Noppens RR, Turkstra T, et al; EMMA Trial Investigators Group. A multicentre randomised controlled trial of the McGrath™ Mac video laryngoscope versus conventional laryngoscopy. Anaesthesia. 2023 Jun;78(6):722-729.
2. Thaler A, Mohamod D, Toron A, Torjman MC. Cost comparison of 2 video laryngoscopes in a large academic center. Journal of Clinical Outcomes Management. 2021 July;28(4):174-179
3. Moucharite MA, et al. Factors and economic outcomes associated with documented difficult intubation in the United States. Clinicoecon Outcomes Res. 2021;13:227–239.
4. Alvis BD, Hester D, Watson D, Higgins M, St Jacques P. Randomized controlled trial comparing the McGRATH™ MAC video laryngoscope with the King Vision video laryngoscope in adult patients. Minerva Anestesiol. 2016;82(1):30–35.
Case study resource
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