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Disposable or reusable blade in laryngoscopy: what choice in Languedoc-Roussillon, France?

2013; Elsevier BV; Volume: 110; Issue: 4 Linguagem: Inglês

10.1093/bja/aet036

1471-6771

Jean‐Christian Sleth, R. Servais, C. Saizy, W. Javitary, E. Lafforgue,

Medical Device Sterilization and Disinfection

Editor—The Creutzfeldt–Jakob crisis started about 1996 and applied essentially to Great Britain and France. Since the blade could be contaminated by lymphocytes during laryngoscopy, a controversy occurred in Great Britain concerning the opportunity of single-use blade (SUB), especially in tonsillectomy.1Hirsch N Beckett A Collinge J Scaravilli F Tabrizi S Berry S Lymphocyte contamination of laryngoscope blades—a possible vector for transmission of variant Creutzfeldt–Jakob disease.Anaesthesia. 2005; 60: 664-667Crossref PubMed Scopus (44) Google Scholar However, in November 2006, the NICE, in the interventional procedure guidance 196, did not support SUB for laryngoscopy. The aim of our study was to assess the state of the practice of laryngoscopy in France, at the scale of a region, more than 15 yr after the beginning of this crisis. A telephonic survey was performed in May 2012. Colleagues of the 41 institutions of the region Languedoc-Roussillon (southern France) were interviewed: two university hospitals, eight general hospitals, five mutualist clinics, and 26 private clinics. The practices in intensive care units, casualty departments, and mobile medical units were excluded. After checking for the practices in the institution, the following questions were asked: (i)what type of blade do you use in everyday practice in your OTs: reusable blade (RUB) or SUB?(ii)in the case of single use, what type—plastic or metallic?(iii)in the case of failure with plastic SUB (PSUB), what is your next choice? Metallic SUB (MSUB), RUB, or do you enter your difficult intubation algorithm? The response rate was 100%; all of the institutions had consensual practices. In 75%, the first choice was SUB with a large dominance of PSUB; MSUB were used only in seven institutions (Fig. 1). In the case of failure with the PSUB, RUB was the dominant alternative. RUB was used as the first choice in only 25% of the institutions. The practices were different according to the administrative status (Table 1).Table 1Type of blade and procedures according to the type of institution. RB, reusable blade; MSUB, metallic single-use blade; PSUB, plastic single-use bladeUniversity hospital (n=2)General hospital (n=8)Mutualist clinic (n=5)Private clinic (n=26)RB10MSUB142PSUB next RB1247PSUB next MSUB212PSUB next protocol5 Open table in a new tab This survey shows that at a regional scale, SUB is widely used with a predominance of the plastic blades, although RUB is an acceptable alternative in France. Thus, in December 2011, the health authorities in France updated the guidelines in the ‘instruction DGS/449' giving the choice between SUB and RUB. RUB is acceptable, provided that sterilization is performed in accordance with good sterilization practices, that is, 134°C and 18 min cycle, considered as efficient against the prion.2Rutala WA Weber DJ Society for Healthcare Epidemiology of AmericaGuideline for disinfection and sterilization of prion-contaminated medical instruments.Infect Control Hosp Epidemiol. 2010; 31: 107-117Crossref PubMed Scopus (124) Google Scholar During the last decade, decontamination of RUB has been variable in Europe3Esler MD Baines LC Wilkinson DJ Langford RM Decontamination of laryngoscopes: a survey of national practice.Anaesthesia. 1999; 54: 587-592Crossref PubMed Scopus (56) Google Scholar 4Bucx MJ Dankert J Beenhakker MM Harrison TE Decontamination of laryngoscopes in The Netherlands.Br J Anaesth. 2001; 86: 99-102Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar and rarely in accordance with the international guidelines. Surprisingly, in our region, PSUB is the dominant choice even though it makes laryngoscopy more difficult for anaesthetists.5Twigg SJ McCormick B Cook TM Randomized evaluation of the performance of single-use laryngoscopes in simulated easy and difficult intubation.Br J Anaesth. 2003; 90: 8-13Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar This has led some authors not to recommend the use of PSUB in the case of rapid sequence induction.6Amour J Marmion F Birenbaum A et al.Comparison of plastic single-use and metal reusable laryngoscope blades for orotracheal intubation during rapid sequence induction of anesthesia.Anesthesiology. 2006; 104: 60-64Crossref PubMed Scopus (43) Google Scholar The economical aspect of single use is potentially important, since in France, the annual number of intubations is estimated at 2.5–3 millions, and the general use of SUB would generate an extra cost of about 5–20 million Euros depending on the type of blade (plastic or metallic). The benefit of SUB remains unclear, especially as the prevalence of the prion in tonsils has been probably overestimated.7Clewley JP Kelly CM Andrews N et al.Prevalence of disease related prion protein in anonymous tonsil specimens in Britain: cross sectional opportunistic survey.Br Med J. 2009; 338: b1442Crossref PubMed Scopus (89) Google Scholar Sustainable anaesthesia is beginning to be a topic in the recent literature.8Ryan S Sherman J Sustainable anesthesia.Anesth Analg. 2012; 114: 921-923Crossref PubMed Scopus (27) Google Scholar The SUB may be a new source of medical waste, and its carbon footprint is certainly not negligible considering the import from emergent countries.9Sleth JC Lame réutilisable: épargnons la planète et notre argent.Can J Anaesth. 2012; 59: 720-721Crossref PubMed Scopus (0) Google Scholar Disposable blade in laryngoscopy seems presently well established in Languedoc-Roussillon. SUBs are a source of medical waste, thus this practice should be re-analysed in a spirit of sustainable development and risk–benefit balance. None declared.