Authors: McGee M et al.
Anesthesia Patient Safety Foundation Newsletter, volume 41, number 1, February 2026.
Summary
This article examines the patient safety, ethical, and operational trade-offs of reusable versus single-use airway devices in humanitarian anesthesia, drawing on firsthand experience during the Continuing Promise 2025 mission aboard the USNS Comfort. The author emphasizes that airway equipment decisions in resource-limited environments must balance clinical reliability, infection control, environmental impact, and supply-chain resilience.
During the mission, reusable rigid stylets were found to lose reliability after repeated sterilization cycles. Progressive deformation resulted in unpredictable curvature and reduced effectiveness, particularly during unanticipated difficult airway situations. Objective measurements demonstrated wide variation in reusable stylet angulation compared with consistent geometry in single-use devices. These deviations were clinically meaningful, with potential displacement of the stylet tip by distances comparable to or exceeding the anteroposterior width of the adult glottis. In time-critical airway scenarios, this unreliability created safety risks and required mid-procedure equipment changes.
Sterilization infrastructure limitations further complicated the use of reusable equipment. Nightly reprocessing demands constrained operating room workflow and created vulnerabilities related to sterilizer availability, maintenance, and throughput. In austere or shipboard environments, these bottlenecks can force airway planning around equipment logistics rather than patient needs.
Single-use airway devices offered clear performance advantages, including consistent geometry, immediate readiness, and simplified infection control. However, their use introduced significant challenges. Disposable devices generated large volumes of medical waste, straining shipboard segregation processes and host-nation disposal capabilities. Environmental considerations were particularly salient in regions lacking robust waste management infrastructure, raising ethical concerns about exporting unsustainable care models.
Supply reliability and cost also emerged as critical issues. Despite extensive planning, delays in delivery of single-use equipment underscored the vulnerability of disposable-only strategies. Depletion of disposable supplies mid-mission could necessitate reliance on compromised reusable devices. While reusable equipment may offer substantial long-term cost savings across repeated missions, its safety depends on durability, inspection, and effective reprocessing capacity.
Based on these experiences, the author advocates for a hybrid airway equipment strategy in humanitarian settings. Maintaining both reusable and single-use options for critical airway tools allows flexibility in response to equipment failure, sterilization delays, and supply-chain disruptions. Enhanced monitoring protocols for reusable devices, redundant procurement planning, and predeployment coordination with host nations on waste management are emphasized as essential components of patient safety.
The article concludes that airway management decisions in humanitarian anesthesia are inherently systems-level choices. Protecting patients requires attention not only to technical performance but also to environmental stewardship, ethical responsibility, and long-term impact on host communities. Sustainable, patient-centered airway strategies must integrate clinical reliability with logistical and environmental realities.
Key Points
Airway equipment reliability is critical for patient safety in humanitarian and austere settings
Reusable rigid stylets may deform after repeated sterilization, leading to unpredictable performance
Single-use airway devices provide consistent performance but introduce waste, supply, and cost challenges
Sterilization capacity can become a limiting factor that affects operating room efficiency and safety
Hybrid strategies combining reusable and single-use equipment provide flexibility and redundancy
Routine inspection and monitoring of reusable airway devices are essential
Predeployment planning should address waste disposal, supply-chain resilience, and local infrastructure
Thank you to the Anesthesia Patient Safety Foundation for allowing us to summarize and share this APSF Newsletter article focused on airway safety in humanitarian anesthesia.