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

[McGee] “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.”

Our show focuses on the Continuing Promise 2025 humanitarian mission about the USNS Comfort. These are the 4 Evidence-Based patient safety focused strategies:

1. Hybrid Equipment Strategy:
   Maintain both reusable and single-use options for critical airway tools.
2. Enhanced Equipment Monitoring Protocols:
   Implement systematic inspection protocols for reusable devices, such as rigid stylets prone to deformation.
3. 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.
4. 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, Alli 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. Reuseable 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 are going to explore today.

Before we dive further into the episode today, 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 vs. Single-Use Airway Devices in Humanitarian Anesthesia: Lessons from Continuing Promise 2025 Aboard the USNS Comfort” by Matt McGee. 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, you can 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.

[McGee] “ Hi, my name is Matt McGee. I’m a navy anesthesiologist and I served as the department head for anesthesiology aboard the US NS Comfort during our deployment. In support of Continuing Promise 2025.”

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

[McGee] “ 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.”

[Bechtel] 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 16^th iteration of this medical mission, the anesthesia team on the USNS Comfort sought to answer the question: Should airway equipment prioritize reuseable or single-use devices? This is a great question and it’s complicated. It isn’t just about the 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 16-25 times more greenhouse gas emissions then reuseable 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 the reuseable GlideRite stylets. After multiple sterilization cycles and routine handling, there was progressive deformation which made the stylets difficult or impossible to use effectively. There were 2 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 reuseable stylets. This delay during a critical moment of anesthesia care could  be a threat to safe anesthesia care.

The anesthesia team carefully evaluated the differences between the reuseable and single-use stylets. The single-use stylets had a consistent handle-to-tip angle of about 14.92 degrees. The 10 reuseable 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 -19mm to +31.8mm. Since the average adult male glottis measures 21.5mm in anteroposterior 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 reuseable 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 reuseable stylet can directly compromise patient safety when seconds count.

The anesthesia team also used reuseable direct laryngoscope blades which needed to be re-processed every night to make sure there appropriate availability for the cases each day in the 3-4 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. First, the clinical advantages include consistent performance and immediate readiness when it comes to the single-use glideslope stylets. The team recognized that not having disposable direct laryngoscope 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. 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 that 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 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 stylets available leading to reliance on compromised reuseable equipment. Another important consideration is redundant equipment planning to ensure availability. Cost is another factor and having reuseable airway equipment available may offer a 10-fold cost reduction especially over the course of multiple humanitarian missions.

Now, it’s time for some evidence-based recommendations for patient safety-focused strategies.

1. 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.
2. Enhanced Equipment Monitoring Protocols: There needs to be systematic inspection protocols for reuseable devices. Staff training should emphasize recognition of subtle performance degradation that may not be visually apparent but could compromise clinical effectiveness.
3. Redundant Supply Chain Planning: Make sure that there is a 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.
4. 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.

[McGee] “ 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 stylets 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.”

[Bechtel] Thank you so much for 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 [email protected]. 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 1, 2026 and the APSF will sponsor the winners to attend the 2026 Stoelting Conference in National Harbor Maryland to share your work and network with attendees. Here’s how to submit your work. You may independently determine he best media for submitting your project summary. Acceptable formats include a document or an audio or video recording. The submission deadline is June 1, 2026 so you have some time to get organized and excited to submit your best work and support he APSF vision. Check out the show notes for more information about the submission process. You can also email [email protected] with any questions.

Until next time, stay vigilant so that no one shall be harmed by anesthesia care.

© 2026, The Anesthesia Patient Safety Foundation