Choice of scopes to use for DISE procedures?

[neuroride]

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Our surgery center is planning on doing more DISE and Inspire procedures. The ENTs need a fiberoptic scope for the DISE part. Any suggestions or ideas on what people use now for this? We are not looking for an expensive/big setup. Right now we borrow the glidescope flexible bronch from the hospital across the street but we will need our own eventually.

 

[cittykat]

Our surgery center is planning on doing more DISE and Inspire procedures. The ENTs need a fiberoptic scope for the DISE part. Any suggestions or ideas on what people use now for this? We are not looking for an expensive/big setup. Right now we borrow the glidescope flexible bronch from the hospital across the street but we will need our own eventually.

You “borrow” a single use disposable bronchoscope from the hospital? You don’t stock a FOB for difficult airways?

Surgicenters are so cheap 😂

 

[Arch Guillotti]

Our surgery center is planning on doing more DISE and Inspire procedures. The ENTs need a fiberoptic scope for the DISE part. Any suggestions or ideas on what people use now for this? We are not looking for an expensive/big setup. Right now we borrow the glidescope flexible bronch from the hospital across the street but we will need our own eventually.

Abbreviations that are not well known are annoying. Our ENT guy doesn’t do any inspire patients at the surgery center due to cost concerns.

 

[neuroride]

You “borrow” a single use disposable bronchoscope from the hospital? You don’t stock a FOB for difficult airways?

Surgicenters are so cheap 😂

No we have a glideacope and McGraths for difficult airways

 

[neuroride]

Abbreviations that are not well known are annoying. Our ENT guy doesn’t do any inspire patients at the surgery center due to cost concerns.

They actually pay really well for the center so we are eager to start doing more of them.

 

[Arch Guillotti]

Our surgery center is planning on doing more DISE and Inspire procedures. The ENTs need a fiberoptic scope for the DISE part. Any suggestions or ideas on what people use now for this? We are not looking for an expensive/big setup. Right now we borrow the glidescope flexible bronch from the hospital across the street but we will need our own eventually.

Why is the anesthesia dept involved at all in scope procedure? The ENT guy is the one using it.

 

[operaman]

Lots of good options. If your center already uses a particular brand for reusable scopes (Olympus, storz, Pentax, etc) and already has equipment to process them, pretty cheap to buy/lease a flexible laryngoscope in that system. How many you need will depend on your cleaning speed and case volume of course.

The cheapest entry option would be disposable scopes. I know Olympus has them as does Ambu. If you’re doing lower volume these may be more cost effective early on and then can purchase reusable once the needs are known and it makes financial sense. Check with your ent if they want to take pictures or videos as that’s a bit clunkier in disposable systems. Olympus and Pentax can just port directly into their cloud storage options.

There’s definitely a point where disposable loses money - my hospital floated the idea once for my clinic and ran the numbers - would have cost them $2.2m a year in scopes! So that idea died quickly! Surgicenter may be different though since you may be able to recoup the unit cost in your facility fee.

Overall I think DISE is a complete waste of time. It’s pretty obvious from the office scope who is a candidate. As such, I don’t think any ent really cares what kind of scope it is since we’re basically just going through the motions to satisfy the insurance gods.

 

[neuroride]

Why is the anesthesia dept involved at all in scope procedure? The ENT guy is the one using it

 

[neuroride]

Why is the anesthesia dept involved at all in scope procedure? The ENT guy is the one using it.

The CEO is simply relying on us to do some research on it, the ENT is ok with whatever but we also want to be somewhat cost conscious on it

 

[cittykat]

They actually pay really well for the center so we are eager to start doing more of them.

The CEO is simply relying on us to do some research on it, the ENT is ok with whatever but we also want to be somewhat cost conscious on it

The disposable glidescope FOBs from Verathon are $250 a piece.

 

[Burned_Out]

I find the disposable Glidescope fiber optic scopes useless for difficult intubations. As you push your ETT along the fiber optic cable, the cable is so malleable your tube is deflected into the esophagus. I had to cancel a case because of this issue after 4 failed attempts to advance the tube.

I like the Ambu brand disposable fiber optic scopes. The cable is rigid enough for difficult airway work and the optic quality is noticeably more clear. The Glidescope brand just looks and feels cheap in my hands compared to the Ambu.

 

[Arch Guillotti]

I find the disposable Glidescope fiber optic scopes useless for difficult intubations. As you push your ETT along the fiber optic cable, the cable is so malleable your tube is deflected into the esophagus. I had to cancel a case because of this issue after 4 failed attempts to advance the tube.

Do the intubation through an LMA then.

 

[cittykat]

I find the disposable Glidescope fiber optic scopes useless for difficult intubations. As you push your ETT along the fiber optic cable, the cable is so malleable your tube is deflected into the esophagus. I had to cancel a case because of this issue after 4 failed attempts to advance the tube.

I like the Ambu brand disposable fiber optic scopes. The cable is rigid enough for difficult airway work and the optic quality is noticeably more clear. The Glidescope brand just looks and feels cheap in my hands compared to the Ambu.

They come in different sizes. The bigger ones are stiffer.

 

[kidthor]

Whatever scope you use, you should be 100% sure the surgery center allocates that cost to surgeon/facility fee cost center and not to anesthesia. Otherwise some uninformed bean counter will bake that into your anesthesia device costs and screw you over.

 

[Burned_Out]

Do the intubation through an LMA then.

Do people still do this? I haven't utilized an intubating LMA in 20 years. Found the whole thing clumsy. Doing fiber optic work through a LMA limits your cable movement. The LMA also can restrict your view as it sometimes obscures the larynx.

 

[Burned_Out]

They come in different sizes. The bigger ones are stiffer.

Unfortunately, most places I've seen only buy 1 size.

 

[Arch Guillotti]

Do people still do this? I haven't utilized an intubating LMA in 20 years. Found the whole thing clumsy. Doing fiber optic work through a LMA limits your cable movement. The LMA also can restrict your view as it sometimes obscures the larynx.

not a fasttrack. Those things were terrible. Fiberoptic thru lma using an MLT tube or an aintree.

 

[neuroride]

I find the disposable Glidescope fiber optic scopes useless for difficult intubations. As you push your ETT along the fiber optic cable, the cable is so malleable your tube is deflected into the esophagus. I had to cancel a case because of this issue after 4 failed attempts to advance the tube.

I like the Ambu brand disposable fiber optic scopes. The cable is rigid enough for difficult airway work and the optic quality is noticeably more clear. The Glidescope brand just looks and feels cheap in my hands compared to the Ambu.

Ambu is definitely on the list to research and price out