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A number of studies in the U.S.A. and mainland Europe have described the costs of fibreoptic tracheal intubation. However, no such data from the UK appear available. We performed a cost assessment of fibreoptic intubation, using re-usable (various devices from Olympus, Acutronic and Karl Storz) and single-use (Ambu aScope) fibrescopes, at the Queens Medical Centre, Nottingham, U.K., between 1 January 2009 and 31 March 2014. The total annual cost of fibreoptic intubation with re-usable fibrescopes was £46,385. Based on 141 fibreoptic intubations per year, this equated to £329 per use, an average dominated by repair/maintenance costs (43%) and capital depreciation costs (42%). In comparison, the total annual cost of using single-use fibrescopes for the same work would have been around £200 per use. The analysis enabled us to develop a generic model, wherein we were able to describe the relationship between total cost of use vs number of uses for a fibrescope. An 'isopleth' was identified for this relationship: a line that joined all the points where the cost of re-usable vs single-use fibrescopes was equal. It appears cheaper to use single-use fibrescopes at up to 200 fibreoptic intubations per year (a range commensurate with normal practice) even when the repair rate for re-usable fibrescopes is low. Any centre, knowing its fibrescope use and repair rate, can plot its data similarly to help ascertain which of the re-usable or single-use fibrescope represents better value., (© 2015 The Association of Anaesthetists of Great Britain and Ireland.)

We investigated the hypothesis that the oropharyngeal leak pressure would differ between the GuardianCPV™ and the LMA Supreme™ in anaesthetised patients. We randomly assigned 120 patients to receive either the GuardianCPV or the LMA Supreme for airway management. Oropharyngeal leak pressure was measured during cuff inflation from 0 to 40 ml in 10-ml steps. In addition, intracuff pressure, fibreoptic position of the airway and drain tube, device insertion success, ventilation success, blood staining and airway morbidity were determined. Mean (SD) oropharyngeal leak pressures for clinically acceptable cuff volumes of 20-40 ml were 31 (7) cmH2O for the GuardianCPV and 27 (7) cmH2O for the LMA Supreme (p < 0.0001); mean (SD) intracuff pressures were 68 (33) cmH2O and 88 (43) cmH2O (p < 0.0001), respectively. We found no differences in device insertion success, ventilation success, fibreoptic position of the airway and drain tube, blood staining or airway morbidity. We conclude that the oropharyngeal leak pressure is better for the GuardianCPV than for the LMA Supreme in anaesthetised patients., (Anaesthesia © 2013 The Association of Anaesthetists of Great Britain and Ireland.)

In a randomised crossover study, 60 ambulance paramedics attempted tracheal intubation of a manikin model of a Cormack and Lehane grade 3/4 view using a Portex stylet, Portex and Frova single-use bougies, and a Portex reusable bougie. Tracheal intubation within 30 s was achieved by 34/60 (57%) using the stylet, 18/60 (30%) using a Portex single-use bougie, 16/60 (27%) using a Frova single-use bougie and 5/60 (8%) using a Portex reusable bougie. The proportion intubating within 30 s was significantly higher with the stylet compared with any bougie (p < 0.001), but significantly lower with a Portex reusable bougie than any other device (p < 0.004). Participants rated the Portex reusable bougie as significantly more difficult to use than the other devices (p < 0.001). There was no evidence of a relationship between previous experience and success rate for any device., (Anaesthesia © 2012 The Association of Anaesthetists of Great Britain and Ireland.)

Single-use devices are designed, manufactured and sold to be used once and then discarded. This paper addresses growing concerns about the quality of some devices. Single-use devices, manufactured at a lower cost to justify their disposal, are perceived to have a lesser efficacy, which may threaten patient safety through iatrogenic harm. There is, in addition, growing scepticism about the actual risk of contracting variant Creutzfeldt-Jakob disease and other blood-borne diseases from reused surgical instruments. Interview data suggests that when choosing to use a single-use device, clinicians balance concerns about the risk of infection against those about the risk of injury. However, despite reservations about induced harm and the unknown risk of an iatrogenic disease, most clinicians would want single-use devices used on themselves and their family if they were patients.