Anesth Pain Med.  2020 Apr;15(2):173-180. 10.17085/apm.2020.15.2.173.

Clinical performance of Ambu AuraGainTM versus i-gelTM in anesthetized children: a prospective, randomized controlled trial

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea

Abstract

Background
Ambu AuraGain and i-gel have different characteristics in design each other. However, few reports evaluate which device has more benefits for ventilation in children undergoing paralyzed general anesthesia. This prospective, randomized controlled trial compared the clinical performance AuraGain and i-gel in anesthetized children.
Methods
Children aged between 1 month and 7 years undergoing elective surgery were randomly assigned to the AuraGain and i-gel groups. The primary outcome was initial oropharyngeal leak pressure (OLP). Secondary outcomes were OLP at 10 min post-insertion, first-attempt and total insertion success rates, number of attempts and ease of gastric suction catheter placement, peak inspiratory pressure, fiberoptic bronchoscopic view score, ventilation quality, requirement of additional manipulation post-insertion, and complications.
Results
Data of 93 patients were analyzed. The initial OLPs of the AuraGain and i-gel were 27.5 ± 7.7 and 25.0 ± 8.0 cmH2O, respectively (P = 0.13). The OLP was significantly increased 10 min post-insertion in both groups. The initial success rates of the AuraGain and i-gel insertion were comparable. Suction catheter placement via the gastric port was easier (P = 0.02) and fiberoptic bronchoscopic view was better with the AuraGain (P < 0.001). The i-gel required additional manipulations post-insertion (P = 0.04). The incidence of complications during the emergence period was 2.2% for the i-gel and 10.8% for the AuraGain (P = 0.1)
Conclusions
OLP is comparable between AuraGain and i-gel. The AuraGain would be more favorable than the i-gel for use in pediatric patients under general anesthesia considering other outcomes.

Keyword

Airway management; General anesthesia; Laryngeal masks; Pediatric

Figure

  • Fig. 1. Consolidated standards of reporting trials (CONSORT) diagram.


Reference

1. Mihara T, Asakura A, Owada G, Yokoi A, Ka K, Goto T. A network meta-analysis of the clinical properties of various types of supraglottic airway device in children. Anaesthesia. 2017; 72:1251–64.
2. Vaida SJ, Yodfat UA. Angulation of the airway tube in the AMBU laryngeal mask could be responsible for improved insertion success. Anesth Analg. 2006; 103:264.
3. Hagberg CA, Jensen FS, Genzwuerker HV, Krivosic-Horber R, Schmitz BU, Hinkelbein J, et al. A multicenter study of the Ambu laryngeal mask in nonparalyzed, anesthetized patients. Anesth Analg. 2005; 101:1862–6.
4. Jagannathan N, Hajduk J, Sohn L, Huang A, Sawardekar A, Gebhardt ER, et al. A randomised comparison of the Ambu® AuraGain™ and the LMA® supreme in infants and children. Anaesthesia. 2016; 71:205–12.
5. Mihara T, Nakayama R, Ka K, Goto T. Comparison of the clinical performance of i-gel and Ambu AuraGain in children: a randomised noninferiority clinical trial. Eur J Anaesthesiol. 2019; 36:411–7.
6. Kim HJ, Park HS, Kim SY, Ro YJ, Yang HS, Koh WU. A randomized controlled trial comparing Ambu AuraGain and i-gel in young pediatric patients. J Clin Med. 2019; 8:E1235.
7. Kobayashi M, Ayuse T, Hoshino Y, Kurata S, Moromugi S, Schneider H, et al. Effect of head elevation on passive upper airway collapsibility in normal subjects during propofol anesthesia. Anesthesiology. 2011; 115:273–81.
8. Xue FS, Mao P, Liu HP, Yang QY, Li CW, He N, et al. The effects of head flexion on airway seal, quality of ventilation and orogastric tube placement using the ProSeal laryngeal mask airway. Anaesthesia. 2008; 63:979–85.
9. Keller C, Brimacombe JR, Keller K, Morris R. Comparison of four methods for assessing airway sealing pressure with the laryngeal mask airway in adult patients. Br J Anaesth. 1999; 82:286–7.
10. Okuda K, Inagawa G, Miwa T, Hiroki K. Influence of head and neck position on cuff position and oropharyngeal sealing pressure with the laryngeal mask airway in children. Br J Anaesth. 2001; 86:122–4.
11. Lee YC, Yoon KS, Park SY, Choi SR, Chung CJ. A comparison of i-gel™ and Laryngeal Mask Airway Supreme™ during general anesthesia in infants. Korean J Anesthesiol. 2018; 71:37–42.
12. Theiler LG, Kleine-Brueggeney M, Luepold B, Stucki F, Seiler S, Urwyler N, et al. Performance of the pediatric-sized i-gel compared with the Ambu AuraOnce laryngeal mask in anesthetized and ventilated children. Anesthesiology. 2011; 115:102–10.
13. Lee JH, Jang YE, Kim EH, Kim HS, Kim JT. Flexion decreases the ventilation quality of the Ambu® AuraGain™ laryngeal mask in paralysed children: a prospective randomised crossover study. Acta Anaesthesiol Scand. 2018; 62:1080–5.
14. Zhang L, Seet E, Mehta V, Subramanyam R, Ankichetty SP, Wong DT, et al. Oropharyngeal leak pressure with the laryngeal mask airway Supreme™ at different intracuff pressures: a randomized controlled trial. Can J Anaesth. 2011; 58:624–9.
15. Shin HW, Yoo HN, Bae GE, Chang JC, Park MK, You HS, et al. Comparison of oropharyngeal leak pressure and clinical performance of LMA ProSeal™ and i-gel® in adults: meta-analysis and systematic review. J Int Med Res. 2016; 44:405–18.
16. Goldmann K, Hoch N, Wulf H. [Influence of neuromuscular blockade on the airway leak pressure of the ProSeal laryngeal mask airway]. Anasthesiol Intensivmed Notfallmed Schmerzther. 2006; 41:228–32. German.
17. Yoshikawa Y, Hirata N, Nawa Y, Yamakage M. Chronological change in oropharyngeal leak pressure of pediatric i-gel™. Paediatr Anaesth. 2019; 29:107–8.
18. Gabbott DA, Beringer R. The iGEL supraglottic airway: a potential role for resuscitation? Resuscitation. 2007; 73:161–2.
19. Jagannathan N, Sohn LE, Sawardekar A, Shah R, Ryan K, Jagannathan R, et al. A randomised comparison of the self-pressurised air-QTM intubating laryngeal airway with the LMA Unique™ in children. Anaesthesia. 2012; 67:973–9.
20. Jagannathan N, Ramsey MA, White MC, Sohn L. An update on newer pediatric supraglottic airways with recommendations for clinical use. Paediatr Anaesth. 2015; 25:334–45.
21. White MC, Cook TM, Stoddart PA. A critique of elective pediatric supraglottic airway devices. Paediatr Anaesth. 2009; 19 Suppl 1:55–65.
22. Hughes C, Place K, Berg S, Mason D. A clinical evaluation of the i-gel™ supraglottic airway device in children. Paediatr Anaesth. 2012; 22:765–71.
23. Kim H, Lee S, Shin HJ, Lee JH, Choi SR, Chung CJ. A clinical evaluation of i-gelTM during general anesthesia in children. Anesth Pain Med. 2015; 10:46–51.
24. Prakash M, Johnny JC. Whats special in a child's larynx? J Pharm Bioallied Sci. 2015; 7(Suppl 1):S55–8.
25. Mizushima A, Wardall GJ, Simpson DL. The laryngeal mask airway in infants. Anaesthesia. 1992; 47:849–51.
26. Bagshaw O. The size 1.5 laryngeal mask airway (LMA) in paediatric anaesthetic practice. Paediatr Anaesth. 2002; 12:420–3.
27. Uppal V, Fletcher G, Kinsella J. Comparison of the i-gel with the cuffed tracheal tube during pressure-controlled ventilation. Br J Anaesth. 2009; 102:264–8.
28. Stögermüller B, Ofner S, Ziegler B, Keller C, Moser B, Gasteiger L. Ambu® Aura Gain™ versus Ambu® Aura Once™ in children: a randomized, crossover study assessing oropharyngeal leak pressure and fibreoptic position. Can J Anaesth. 2019; 66:57–62.
Full Text Links
  • APM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr