A randomized comparison of the Ambu AuraGain versus the LMA supreme in patients undergoing gynaecologic laparoscopic surgery

Abstract

Second generation supraglottic airway devices providing high seal airway pressures are suitable for patients undergoing gynecologic laparoscopy. We compared the seal pressure achieved by the new Ambu AuraGain™ versus LMA Supreme™ following pneumoperitoneum in the Trendelenburg position. Sixty female patients were randomly allocated to ventilation with either the AuraGain or the Supreme. A target-controlled system was used to administer total intravenous anesthesia. Intracuff pressure was maintained below 60 cm HO. The following parameters were registered: Time, number of attempts and manoeuvres required for insertion; seal pressure and peak inspiratory pressure at four time points; ease of gastric tube insertion, flexible scope view, complications and postoperative morbidity. Both devices were quick and easily inserted, although the Supreme required less rotation manoeuvres (16 in AuraGain vs. 6 in LMA Supreme; p = 0.01). The AuraGain achieved higher seal pressures (34 ± 5 in AuraGain vs. 29 ± 5 in LMA Supreme; p = 0.0002). Following pneumoperitoneum in head-down position, peak airway pressure increased 9 ± 3 cm HO in both groups, exceeding seal pressure in 3 patients in the Supreme group (p = 0.06). The vocal cords were seen through all AuraGain and 90% of the Supreme devices; epiglottis was often visible inside the tube (68%). No differences were found in the incidence of traces of blood on the mask or postoperative symptoms. Both devices allowed effective ventilation in patients undergoing gynaecologic laparoscopic surgery with a low rate of complications. The Ambu AuraGain provided higher seal pressures and a clear view of glottic inlet in all patients offering the possibility to guide direct tracheal intubation if required.

The LMA® ProtectorTM in anaesthetised, non‐paralysed patients: a multicentre prospective observational study

“…However, our data are in line with those reported for the LMA Protector in previous studies . The OLP of the LMA Protector was comparable to or even higher than that described for the ProSeal and the Ambu AuraGain, and superior to that of the i‐gel and the LMA Supreme; this finding may be related to the cuff material and design of the LMA Protector .…”

“…The overall success rate of the LMA Protector found in our present study (98%) is comparable to other second‐generation SADs such as the LMA ProSeal TM (91–100%), the LMA Supreme TM (92–100%) and the Ambu AuraGain (92–100%), but inferior to the Classic TM LMA (99.8–100%) . The learning curve with the LMA Protector is probably steeper than that of first‐generation SADs and similar to that of second‐generation SADs, which may justify the fact that 56% of our patients required manoeuvres to facilitate insertion .…”

“…A recent report with a new silicone SAD, the LMA Gastro TM airway, which shares some features with the LMA Protector, reported the presence of blood staining in 76% of 292 patients . The incidence of blood staining after SAD removal ranges between 0% and 50%, and is related to differences in difficulty of insertion, provider experience and patient characteristics .…”

Fiberoptic intubation of severely obese patients through supraglottic airway: A prospective, randomized trial of the Ambu® AuraGain™ laryngeal mask vs the i‐gel™ airway

“…In those studies, an OLP of 25 cmH 2 O was reached . Similar OLP's as in our study were found by Keller in the ProSeal™ laryngeal mask in obese patients and for the AuraGain™ in a study by Lopez et al in patients undergoing gynecologic surgery, as in a study by Moser et al No data on obese patients exist for the AuraGain™. Higher OLP's may be reached because of the better adaptation of the shape of the mask due to the fat deposits in the neck.…”

Comparison of oropharyngeal leak pressure between the Ambu® AuraGain™ and the LMA® Supreme™ supraglottic airways: a randomized-controlled trial

“…[9][10][11] Previous studies have reported conflicting results regarding differences in OLP between the Auragain and the Supreme. Lopez et al 10 compared the Auragain with the Supreme and showed a higher mean OLP of 34 cmH 2 O for the Auragain (vs 29 cmH 2 O in the Supreme). Nevertheless, other studies comparing the Auragain with the Supreme have reported no significant differences in OLP between the two devices.…”