#302 Reusable Versus Single-Use Airway Devices When Seconds Count

A difficult airway is hard enough in a modern hospital. Now imagine managing it on a ship, far from resupply, where “availability supersedes preference” and a device that worked last month might quietly drift out of spec. That’s the tension we unpack while exploring reusable versus single-use airway devices in humanitarian anesthesia and why planning is what protects patients when seconds count.

We’re joined by Matt McGee, a Navy anesthesiologist who served as department head for anesthesiology aboard the USNS Comfort during Continuing Promise 2025. He walks us through what his team saw with reusable airway tools after repeated sterilization and handling, including progressive deformation of rigid stylets and how that kind of performance degradation can turn into delay during unanticipated difficult airway management. From there, we zoom out to the broader patient safety implications: infection control, sterilization capacity, operational throughput in multiple ORs, and the very real consequences of depending on a fragile supply chain for single-use equipment.

We also take sustainability and ethics seriously. Single-use airway equipment can deliver consistency and simplicity, but it increases medical waste and can strain host-nation disposal systems, raising environmental stewardship questions that belong in the same conversation as laryngoscopes and video laryngoscopes. The takeaway is practical and actionable: build a hybrid airway equipment strategy, monitor reusable devices with systematic inspection protocols, plan redundant procurement buffers for disposables, and coordinate pre-deployment waste management with host partners.

If you care about anesthesia patient safety in austere environments, global health, or perioperative systems planning, hit subscribe, share this with a colleague headed on mission work, and leave a review with your best tip for building redundancy without creating unnecessary waste.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/302-reusable-versus-single-use-airway-devices-when-seconds-count/

© 2026, The Anesthesia Patient Safety Foundation

Transcript

Why Availability Beats Preference

SPEAKER_00 0:00

You can't easily replace equipment, so supply availability quickly supersedes personal preference. We noticed that some reusable airway devices had deformed over time, and that raised real safety concerns because in an airway emergency, seconds count. From a patient safety standpoint, we worked hard to ensure we had enough reliable single-use options to cover emergencies. Because in a shipboard humanitarian environment, you need absolute confidence that your equipment will perform exactly as expected. This article is about recognizing that reality and planning deliberately. So when the airway is difficult and time is limited, the equipment is never the weakly.

Humanitarian Anesthesia Safety Challenge

Sponsor Support For APSF

Alli 0:54

Maintain both reusable and single-use options for critical airway tools. Number two, enhanced equipment monitoring protocols. Implement systematic inspection protocols for reusable devices such as rigid stylets prone to deformation. Number three, redundant supply chain planning. Build significant cushion into equipment procurement, particularly for single-use devices. When primary supplies are depleted, alternative equipment options ensure continuity of safe care without compromising clinical standards. And number four, pre-deployment waste management planning. Coordinate with host nations regarding waste acceptance and disposal capabilities before deployment. Hello and welcome back to the Anesthesia Patient Safety Podcast. I'm your host, Allie Bechtel. We are continuing to talk about articles from the February 2026 APSF newsletter today. Have you provided anesthesia care as part of a humanitarian mission? We are talking about some of the challenges and recommendations for providing safe anesthesia care when there are constraints on resources. Reusable rigid stylets help to decrease waste, but may lose reliability after repeated sterilization, which may complicate difficult airway management. So if we rely on single-use devices given their consistent performance, there are increased challenges of waste, supply reliability, and cost. What we need is a hybrid strategy for airway management supplies in humanitarian settings, and that's what we're going to explore today. Before we dive further into the episode, we'd like to recognize Blink Device Company, a major corporate supporter of APSF. Blink Device Company has generously provided unrestricted support to further our vision that no one shall be harmed by anesthesia care. Thank you, Blink Device Company. We wouldn't be able to do all that we do without you. Our featured article is Reusable versus Single Use Airway Devices in Humanitarian Anesthesia. This article is from the February 2026 APSF newsletter. To follow along with us, head over to APSF.org and click on the newsletter heading. The first one down is the current newsletter. Then scroll down until you get to our featured article. And I will include a link in the show notes as well. Before we get into the article, we have exclusive content from the author. Let's take a listen now.

SPEAKER_00 3:43

Hi, my name is Matt McGee. I'm a Navy anesthesiologist, and I served as the department head for anesthesiology aboard the USNS Comfort during our deployment in support of Continuing Promise 2025. The views expressed in this podcast are those of myself and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States government.

Alli 4:07

I asked Matt what got him interested in this topic. This is what he had to say.

SPEAKER_00 4:13

As the department head on deployment, I felt personally responsible for the overall safety of every anesthetic we delivered. Before we ever left the pier, we scrutinized every piece of equipment we had because once you deploy, what you have is what you have. You can't easily replace equipment, so supply availability quickly supersedes personal preference. We noticed that some reusable airway devices had deformed over time, and that raised real safety concerns because in an airway emergency, seconds count. From a patient safety standpoint, we worked hard to ensure we had enough reliable single-use options to cover emergencies. Because in a shipboard humanitarian environment, you need absolute confidence that your equipment will perform exactly as expected. This article is about recognizing that reality and planning deliberately. So when the airway is difficult and time is limited, the equipment is never the weak link.

The Real Question Behind Reuse

Sustainability Ethics And Infection Control

Reusable Stylets Deform And Delay Care

Sterilization Limits And Workflow Risk

Single-Use Benefits With Waste Costs

Four Patient Safety Recommendations

A Call For Collaboration And Stewardship

What Better Planning Looks Like

Alli 5:03

Thank you so much to Matt for helping to introduce this topic. And now let's get into the article. Continuing Promise is a recurring humanitarian mission that started in 2007 with the goal for providing medical assistance throughout the Caribbean, Central, and South America. During the 16th iteration of this medical mission, the anesthesia team on the USNS Comfort sought to answer the question: Should airway equipment prioritize reusable or single-use devices? This is a great question, and it's complicated. It isn't just about cost here. There are big patient safety implications if equipment is not available or fails to perform, as well as issues related to infection control, environmental sustainability, supply chain reliability, and the long-term impact on host communities. McGee helps answer this question thoughtfully through the lens of patient safety and ethical practice. Let's review some of the sustainability and ethical considerations. Single use devices have the benefits of superior performance, consistency, and simplicity when it comes to infection control. But we cannot overlook the environmental impact or the burden on local waste management systems, especially when we are traveling to provide care. Did you know that single-use laryngoscope handles contribute 16 to 25 times more greenhouse gas emissions than reusable handles? When it comes to reusable equipment, there are important safety implications related to sterilization and consistent performance over time with repeated use and cleaning. Another consideration is the ethical responsibility to make sure that the care model does not overwhelm local systems with unmanageable medical waste, which would undermine the humanitarian principles and harm long-term relationships. Next up, let's take a look at considerations for airway equipment, including laryngoscopes, video laryngoscopes, and rigid stylets in humanitarian settings, which must examine the following availability, durability, sterilization capacity, and waste management. McGee discusses the experience with reusable glide-right stylets. After multiple sterilization cycles and routine handling, there was progressive deformation which made the stylets difficult or impossible to use effectively. There were two events with unanticipated difficult airway management where the anesthesia team had to switch to single-use stylets during airway management due to failure of the reusable stylets. This delay during a critical moment of anesthesia care could be a threat to safe anesthesia. The anesthesia team carefully evaluated the differences between reusable and single-use stylets. The single-use stylets had a consistent handle-to-tip angle of about 14.92 degrees. The 10 reusable stylets had significant variation in this angle measurement from 10.52 degrees, which was a straighter stylet, to 19.28 degrees, which was more curved. Check out figures 1 and 2 in the article for a visual representation of these angle measurements. When compared to a new single-use stylet, there was a corresponding tip location difference ranging from negative 19 millimeters to positive 31.8 millimeters. Since the average adult male glottis measures 21.5 millimeters in anterior-posterior width, these variations are clinically significant and could mean that the tip of the stylet is nearly two glottic widths in either direction. This means that the distorted reusable stylets were not reliable for providing safe and efficient anesthesia care, especially if a difficult airway was encountered. The big takeaway here is that equipment failure from the unreliable deformed reusable stylet can directly compromise patient safety when seconds count. The anesthesia team also used reusable direct laryngoscope blades, which needed to be reprocessed every night to make sure there was appropriate availability for the cases each day in the three to four operating rooms. If there was any increase in surgical volume, however, it would have been difficult to proceed without delays. This could have negatively impacted the operational efficiency and led to less cases being completed on the mission. There are important considerations related to central sterilization, including equipment maintenance issues, interdepartmental backlogs, and environmental control problems affecting storage conditions. Keep in mind that there is a risk to patient safety when airway management planning depends on sterilizer availability. Let's shift our focus to single-use equipment now. First, the clinical advantages include consistent performance and immediate readiness when it comes to the single-use glidescope stylets. The team recognized that not having disposable direct laryngoscopes was a missed opportunity and could have filled a need from performance degradation and reprocessing delays. The waste management challenges are immediately apparent in the shipboard setting, however. Proper disposal required careful separating of paper, plastic, and metal components, since this was a requirement for the host nations. There was a shipboard incinerator that was used for paper products whenever possible, but the accumulation of medical-grade plastics led to logistical challenges and ethical concerns regarding disposal, especially for communities that were not equipped to handle the waste. Another concern with single-use disposable equipment is dependence on supply chain availability. In the environment of this humanitarian mission, availability supersedes preference. This is a key consideration and a vulnerability for reliance on single-use items. Equipment that may be considered outdated in well-resourced facility may become invaluable if it is immediately available and able to be sterilized. The anesthesia team on the USNS Comfort experienced this when in the middle of the mission there were no more disposable silets available, leading to reliance on compromised reusable equipment. Another important consideration is redundant equipment planning to ensure availability. Cost is another factor, and having reusable airway equipment available may offer a tenfold cost reduction, especially over the course of multiple humanitarian missions. Now it's time for some evidence-based recommendations for patient safety-focused strategies. Number one, hybrid equipment strategy. It is important to maintain both reusable and single-use options for critical airway tools. This approach provides operational flexibility to respond to variation in case schedule and complexity, sterilization delays, and supply chain disruptions while maintaining consistent patient safety standards. Number two, enhanced equipment monitoring protocols. There needs to be systematic inspection protocols for reusable devices. Staff training should emphasize recognition of subtle performance degradation that may not be visually apparent, but could compromise clinical effectiveness. Number three, redundant supply chain planning. Make sure that there is significant cushion when planning equipment procurement, particularly for single-use devices. When primary supplies are depleted, alternative equipment options ensure continuity of safe care without compromising clinical standards. And finally, number four, pre-deployment waste management planning. This is a crucial step to coordinate with host nations for waste acceptance and disposal capabilities before deployment. Establish agreements for proper medical waste handling that minimize environmental impact while ensuring compliance with local regulations. There were a lot of learning opportunities for the anesthesia team that took part in continuing Promise 2025. It is clear that keeping patients safe during anesthesia care during humanitarian missions requires not only anesthesia skills, but also systems thinking, environmental stewardship, and ethical responsibility. McGee leaves us with the following call to action. The path forward requires continued dialogue between clinical practitioners, equipment manufacturers, and global health organizations to develop sustainable solutions that prioritize patient safety without compromising environmental responsibility. Our commitment to first do no harm must encompass not only the patient on the operating table, but also the world we leave behind. Before we wrap up for today, we are going to hear from Matt again. I also asked, what do you hope to see going forward? Let's take a listen to what he had to say.

SPEAKER_00 14:34

I hope to see anesthesia teams, especially those working in humanitarian or austere environments, shift toward more deliberate systems-based planning around airway equipment. That means moving away from single solution thinking and toward hybrid strategies that balance reliability, redundancy, and sustainability. Video laryngoscopes that use standard Mac or Miller blades already exist, but intentionally planning for their availability, especially reusable versions, gives clinicians greater flexibility to use standard silettes, reduces reliance on proprietary hyper-angulated designs, and helps preserve those specialized tools for when they're truly needed. I also hope manufacturers and global health organizations continue to collaborate with clinicians who actually work in these settings, so equipment is designed with durability and real-world use in mind.

Trainee QI Program Announcement

Contact Info And Closing

Alli 15:24

Thank you so much to Matt for contributing to the show today and your work in this area. If you have any questions or comments from today's show, please email us at podcast atapsf.org. Please keep in mind that the information in this show is provided for informational purposes only and does not constitute medical or legal advice. We hope that you will visit APSF.org for detailed information and check out the show notes for links to all the topics we discussed today. We are excited to announce the 2026 APSF Trainee Quality Improvement Patient Safety Recognition Program. This program hosts tracks for physician anesthesiology residents, nurse anesthesia students, and student anesthesiology assistants. Eligible participants include current trainees and those who graduated in the immediately prior academic year. This is your chance to demonstrate your program's work in patient safety and QI initiatives. The winner in each track will be notified around August 1st, 2026, and the APSF will sponsor the winners to attend the 2026 Stolting Conference in National Harbor, Maryland to share your work and network with attendees. Here's how to submit your work. You may independently determine the best media for submitting your project summary. Acceptable formats include a document or an audio or video recording. The submission deadline is June 1st, 2026, so you have some time to get organized and excited to submit your best work and support the APSF vision. Check out the show notes for more information about the submission process. You can also email traineeqi at apf.org with any questions. Until next time, stay vigilant so that no one shall be harmed by anesthesia care.