'Greening' ORs Through Laryngoscope Recycling: Implications for Pediatric Anesthesia Practice

Jacklyn Ma, Wanda Chin, Allison R. Thompson, Elizabeth E. Hansen

Original article

Patel P, Schepel S, Desai R, Potestio C. ‘greening’ ORs through laryngoscope recycling. ASA Monitor 2025;89:e4–5. https://doi.org/10.1097/01.asm.0001108772.16259.cb (link)

As April is Earth Month, the recent publication of the ASA Monitor article titled, ‘Greening' ORs Through Laryngoscope Recycling, is a timely reminder to all of us to educate and raise awareness about environmental issues. As anesthesia clinicians watching the steady stream of single-use disposable (SUD) laryngoscopes fill our OR waste bins, the authors should be commended for their valuable achievements in recycling. However, it's important to emphasize the limitations of recycling, which—as the authors themselves acknowledge—offers only minimal environmental benefits compared to reusable alternatives.

Background

The article highlights several important points: Healthcare facilities contribute significantly to environmental waste, producing approximately 4 billion tons annually and accounting for 8.5% of U.S. CO₂ emissions. By implementing a recycling program, the authors were able to divert an impressive amount of material from landfills—over 1,185 pounds of aluminum and 1,366 pounds of iron in just 14 months. This represents tangible progress in an era when ORs generate up to 70% of hospital waste. The authors highlight SUD laryngoscopes as a key opportunity for reducing environmental impact, given their widespread use, and demonstrate that anesthesia clinicians are well-positioned to lead sustainability efforts in healthcare (1).

What we already know

Research cited in the article provides persuasive evidence regarding the superior environmental benefit of reusable laryngoscopes over SUD options. Sherman et al showed that SUD laryngoscope blades and SUD handles produce 6-8 times and 25 times more greenhouse gas (GHG) emissions, respectively, than reusable options (2). Another study demonstrated that using reusable blades for 17,200 intubations resulted in a reduction of emissions equivalent to driving 74,000 car miles (3).

The Society for Pediatric Anesthesia's recent One-Pager reinforces this position with compelling economic data. Reusable handles become more cost-effective after just 4-5 uses, while blades achieve cost efficiency after 5-7 uses. One hospital projected annual savings between $675,000-$869,000 by transitioning to reusable equipment (4). The economic case for alternatives to SUD laryngoscopes continues to strengthen given the potential tariffs on imported medical supplies—as the authors astutely note, nearly all SUD steel laryngoscopes are manufactured in Pakistan (1). In addition, transitioning to reusable equipment would buffer both the economical and practical impact of supply chain issues as we experienced during the COVID-19 pandemic (7).Other Points to Consider

It is worth noting the conflicting infectious designations placed on laryngoscope handles by the American Society of Anesthesiologists (ASA), The Association of Perioperative Registered Nurses (AORN), and The Joint Commission. This creates unnecessary confusion, complicates hospital sterilization protocols, and results in wasteful practices. It's questionable why laryngoscope handles, which rarely contact patients, require the same rigorous disinfection as blades given that research demonstrates that handles treated with low-level disinfection (LLD) show no pathogenic bacterial or viral contamination (5). Of note, Sherman et al demonstrated that high-level disinfection (HLD) has lower GHG emissions compared to LLD and sterilization of reusable laryngoscope handles. The higher emissions from LLD is likely driven by excessive use of disinfectant wipes, while the use of sterilization for reusable laryngoscope handles is excessive, emphasizing the importance of avoiding overcleaning (2).

Even more concerning is our normalized practice of discarding disposable laryngoscope handles with non-removable batteries after mere seconds of use—an environmental and public health negligence we've collectively accepted. While the battery recycling program in Patel's article (recovering 135 pounds of battery lead) represents progress, transitioning to reusable systems would eliminate this practice entirely (1). Ideally, professional organizations such as the ASA would develop a consensus statement to clarify this issue and eliminate these environmentally harmful and wasteful practices.

No commentary on SUD medical devices would be complete without the mention of the idea of planned obsolescence, an economics principle used by companies to drive profits. By labeling SUD laryngoscopes as “single-use,” despite the capability of multiple uses and lack of safety concerns, the profit motives are obvious and powerful. Understandably, hospitals and regulatory bodies are hesitant to deviate from manufacturers’ instructions for use (IFU), creating a perfect storm where economically and environmentally wasteful practices become institutionalized despite lacking evidence-based justification.

Limitations and Alternatives

The article acknowledges important limitations, noting that recycling offers fewer environmental benefits than reusing and requires investment in specialized waste streams, while manufacturer "greenwashing" may exaggerate environmental claims. Costs of recycling were not included in this analysis (at my (EH) institution, recycling of laryngoscope blades and handles would have cost $50/box if we had switched to SUD in 2019, when we were considering this). Reprocessing presents a viable alternative for institutions hesitant to adopt traditional reusable laryngoscopes. This FDA-regulated practice involves specialized companies collecting, cleaning, testing, sterilizing, and reselling "single-use" devices at lower cost. These companies validate that the devices work as they were originally manufactured and assume liability for reprocessed devices. The benefits are notable: reprocessed devices typically cost 40-60% less than new ones and divert thousands of tons of medical waste from landfills annually. Though less sustainable than true reusable systems, reprocessing offers an intermediate step that operates within existing regulatory frameworks while challenging the presumption that "single-use" designations always reflect clinical necessity or evidence-based practice (6).

Relevance to Pediatric Anesthesia Practice

As pediatric anesthesia clinicians performing frequent intubations, three key considerations emerge: (1) The pediatric context requires more blade varieties, potentially increasing waste generation; (2) a recycling program offers one, but less than ideal, alternative to landfill disposal for SUD laryngoscopes; and (3) alternative solutions can follow multiple paths—prioritizing reusable systems, recycling disposables, reprocessing, or adopting hybrid approaches. Engaging departmental leadership and hospital epidemiology remains crucial for meaningful sustainability impact.

Conclusion

Pediatric anesthesia clinicians have a unique opportunity to champion healthcare sustainability by advocating for deliberate equipment choices. The evidence clearly favors reusable laryngoscope systems for their superior environmental and economic benefits, though well-designed recycling and reprocessing programs offer valuable alternatives when SUD devices are necessary. Each department should thoughtfully assess their specific needs when determining an approach while balancing the environmental impacts of their choices. As clinicians committed to protecting public health, we must acknowledge that sustainable practices are an integral part of providing responsible medical care and advocate for alternative solutions that reduce medical waste and carbon emissions. In doing this, we’re upholding our professional obligation to “do no harm" and investing in the long-term health of the very children we treat daily. What are your experiences with reusable versus SUD laryngoscopes in your practice? Does your department have SUD or reusable laryngoscopes? If you have SUD laryngoscopes, do you have a recycling or reprocessing program? What barriers has your department faced in creating a more sustainable workflow? We’d love to hear your thoughts and comments….send to Myron who will post in a Friday reader response.

References:

1. Patel P, Schepel S, Desai R, Potestio C. ‘greening’ ORs through laryngoscope recycling. ASA Monitor 2025;89:e4–5. https://doi.org/10.1097/01.asm.0001108772.16259.cb (link)

2. Sherman JD, Raibley LA 4th, Eckelman MJ. Life Cycle Assessment and Costing Methods for Device Procurement: Comparing Reusable and Single-Use Disposable Laryngoscopes. Anesth Analg 2018;127:434–43. https://doi.org/10.1213/ANE.0000000000002683.

3. Rouvière N, Chkair S, Auger F, Cuvillon P, Leguelinel-Blache G, Chasseigne V. Reusable laryngoscope blades: a more eco-responsible and cost-effective alternative. Anaesth Crit Care Pain Med 2023;42:101276. https://doi.org/10.1016/j.accpm.2023.101276.

4. Society for Pediatric Anesthesia. Reusable vs. Single-Use Laryngoscopes in Anesthesia Practice. 2022. https://pedsanesthesia.org/wp-content/uploads/2022/09/SPA-disposable-one-pager-V3.pdf

5. Call TR, Auerbach FJ, Riddell SW, et al. Nosocomial contamination of laryngoscope handles: challenging current guidelines. Anesth Analg. 2009;109:479-83.

6. Kwakye G, Brat GA, Makary MA. Green surgical practices for health care. Arch Surg. 2011;146(2):131-136

7. Herr MMH, Segura LG. Sustainable anesthesia: limiting waste, maximizing resiliency. APSF Newsletter. 2023;38:96–99.