Objective. To compare the view at simulated direct laryngoscopy obtained with a standard laryngoscope, with and without a disposable cover and a disposable laryngoscope blade. Design. Randomized non-blinded comparison. Setting. The high-fidelity human patient simulator at the Scottish Clinical Simulation Centre. Participants. Thirty-two anaesthetists with between 11 months and 25 years of experience. Interventions. A randomized comparison of ease of laryngoscopy with each laryngoscope option for simulated easy and difficult laryngoscopy. Main outcome measures.The best grade achievable at laryngoscopy (Cormack and Lehane grade) for each laryngoscope, for both easy and difficult laryngoscopy. Results. For the easy setting, 34% (P = 0.001) of anaesthetists graded laryngoscopy more difficult with the covered laryngoscope, and 22% (P = 0.008) with the disposable laryngoscope considered laryngoscopy more difficult than with the standard laryngoscope. For the difficult simulator setting, 69% (P < 0.001) found laryngoscopy more difficult with the covered laryngoscope and 69% (P < 0.001) with the disposable laryngoscope, when compared with the standard laryngoscope. There was no difference between the laryngoscopy grades for the covered and disposable laryngoscope for either easy (P = 0.21) or difficult (P = 0.87) simulation. Conclusions. Single-use equipment, as presently recommended for tonsillectomy surgery by the UK Department of Health, makes laryngoscopy more difficult for anaesthetists.