Airway Equipment in Private Practice

In training, we get used to having a wide array of devices for placing a breathing tube. This is the purpose of education; each device helps us better familiarize ourselves with airway anatomy, anesthetic techniques, and decision-making in challenging cases. But the truth is, only a handful of techniques have been shown to be definitively better than standard laryngoscopy in clinical trials. Most of the other fancy devices are just that. So in private practice, where it isn't cost-efficient to stock every single gadget and gizmo, we have only a minimum selection of devices. At first, this feels like a disappointment, but over time, I've realized I simply don't need access to every single new device. In fact, it's probably better to be proficient at only a few approaches rather than mediocre at many. With a gum-elastic bougie, video laryngoscope, and fiberoptic bronchoscope, I should be able to intubate any patient. And, those are the techniques (along with an intubating LMA) which have been shown through trials to be the most effective in the difficult airway. I do miss the unusual techniques (gum-elastic bougie, intubating with an Aintree catheter, lightwand) that I no longer use. But I also feel that I've gotten better at my technique with simple direct laryngoscopy since I have fewer backups to bail me out.