Comparison of I-Gel and Auragain in Airway Management

Abstract

Objective: We aimed to compare the superiority of I-Gel and Auragain, the second-generation supraglottic airway devices (SGAD) with different cuff structures, in terms of speed and ease of placement, oropharyngeal leak pressure (OLP), resistance of gastric contents, and post-operative oropharyngeal pain. Materials and Methods: A total of 70 patients aged 18-65 years, with ASA scores I-II, who used I-Gel or Auragain to provide airways under general anesthesia were included in the study. Patients were divided into two groups as I-Gel and Auragain according to the type of SGAD used. Results: OLP, placement duration and Visual Analogue Score (VAS) were found to be statistically significantly higher in the Auragain group (p<0.05). In addition, a moderate positive correlation was found between VAS score and placement duration and number of attempts (p<0.05). Gastric decompression success was similar in both groups (p>0.05). Conclusion: The use of I-Gel provides faster airway and less postoperative throat ache. The use of Auragain provides more efficient ventilation and higher OLP values. In addition, throat ache increases with the number of attempts and the duration of placement in both groups.

Keywords

• Airway management
• Auragain
• I-Gel
• oropharyngeal leak pressure

Havayolu Yönetiminde I-Gel ile Auragain Kullanımının Karşılaştırılması

Öz

Amaç: Kaf yapıları birbirinden farklı olan ikinci nesil supraglottik havayolu araçları (SGAD)’ ndan I-Gel ve Auragain’in yerleştirme hızı ve kolaylığı, oluşturdukları orofaringeal kaçak basıncı (OKB), mide içeriğinin direnajı, post-operatif orofarinkste neden oldukları ağrı bakımından birbirlerine olan üstünlüklerini karşılaştırılmayı amaçladık. Materyal ve Metot: Çalışmaya 18-65 yaş arası, ASA skoru I-II olan, genel anestezi altında havayolu sağlanması için I-Gel veya Auragain kullanılan toplam 75 hasta dahil edildi. Hastalar kullanılan SGAD türüne göre I-Gel ve Auragain olarak iki gruba ayrıldı. Bulgular: OKB, yerleştirme süresi ve Vizüel Analog Skala (VAS) skorlarının Auragain grubunda istatistiksel olarak anlamlı düzeyde yüksek olduğu bulundu (p<0.05). Ayrıca VAS skoru ile yerleştirme süresi ve deneme sayısı arasında pozitif yönde orta düzey korelasyon saptandı (p<0.05). Her iki grubun mide dekompresyonu başarısı ise benzer bulundu (p>0.05). Sonuç: I-Gel kullanımı ile daha hızlı havayolu sağlanmakta ve daha az postoperatif boğaz ağrısı oluşmaktadır. Auragain kullanımı ise daha etkin ventilasyon ve daha yüksek OKB değeri sağlamaktadır. Ayrıca her iki grupta da deneme sayısı ve yerleştirme süresinin fazla olması ile boğaz ağrısı artmaktadır.

Anahtar Kelimeler

• Auragain
• havayolu yönetimi
• I-Gel
• orofaringeal kaçak basıncı

Kaynakça

1. Deligöz Ö, Kozanhan B. Best Predictors of Difficult Laryngoscopy in Somali Patients: A Prospective Observational Study. Int Medical J. 2022;29(6):345-347.
2. Sharma B, Sahai C, Sood J. Extraglottic airway devices: Technology update. Med Devices (Auckl). 2017;10:189-205.
3. Cook TM, Kelly FE. Time to abandon the ‘vintage’ laryngeal mask airway and adopt second-generation supraglottic airway devices as first choice. Br J Anaesth. 2015;115(4):497-499.
4. Singh, K. Second Generation Supraglottic Airway (SGA) Devices. IntechOpen. 2020. https://www.intechopen.com/chapters/73593. Accessed July 21, 2022.
5. Ludeña JA, Bellas JJA, Rementeria RA, Alameda LEM. Assessment of awake i-gelTM insertion for fiberoptic-guided intubation in patients with predicted difficult airway: A prospective, observational study. J Anaesthesiol Clin Pharmacol. 2018;34(4):490-495.
6. Singh K, Gurha P. Comparative evaluation of Ambu AuraGainTM with ProSealTM laryngeal mask airway in patients undergoing laparoscopic cholecystectomy. Indian J Anaesth. 2017;61(6):469-474.
7. Gordon J, Cooper RM, Parotto M. Supraglottic airway devices: Indications, contraindications and management. Minerva Anestesiol. 2017;84(3):389-397.
8. Moser B, Keller C, Audigé L, Dave MH, Bruppacher HR. Fiberoptic intubation of severely obese patients through supraglottic airway: A prospective, randomized trial of the Ambu® AuraGainTM laryngeal mask vs the i‐gelTM airway. Acta Anaesthesiol Scand. 2019;63(2):187-194.

9. Sharifuddin, I. I., Teoh, W. H., Tang, E., Hashim, N., & Loh, P. S. (2017). Ambuâ AuraGainTM versus LMA SupremeTM Second SealTM: a randomised controlled trial comparing oropharyngeal leak pressures and gastric drain functionality in spontaneously breathing patients. Anaesthesia and Intensive Care, 45, 244-50.
10. Kumar CM, Van Zundert TC, Seet E, Van Zundert AA. Time to consider supraglottic airway device oropharyngeal leak pressure measurement more objectively. Acta Anaesthesiol Scand. 2021;65(2):142-145.
11. Sabuncu U, Kusderci HS, Oterkus M, et al. AuraGainTM and i-Gel® laryngeal masks in general anesthesia for laparoscopic cholecystectomy: Performance characteristics and effects on hemodynamics. Saudi Med J. 2018;39(11):1082-1089.
12. Deepak GP, Kumar R, Agarwal M, Bharadwaj M, Kumar NG, Sarma R. Comparison of Ambu AuraGain at low cuff pressure, Ambu AuraGain at high cuff pressure and i-gel in relation to incidence of postoperative upper airway complications. Indian J Anaesth. 2021;65(6):439-444.
13. Hur M, Choi S, Row HS, Kim TK. Comparison of the i-gelTM with the AuraGainTM laryngeal mask airways in patients with a simulated cervical immobilization: A randomized controlled trial. Minerva Anestesiol. 2020;86(7):727-735.
14. Pradeep MS, Nandanwankar NK, Lahane PV, Memon NY, Yennawar SD, Pathak RG. A Randomised comparison and evaluation of I-gel, Supreme laryngeal mask airway and Ambu Auragain in Laparoscopic surgeries under general anaesthesia with controlled ventilation. Asian J Med Sci. 2021;12(4):68-75.
15. 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(8):1235.
16. Lakshmi TC, Tiwari T, Agrawal J, Kapoor R, Vasanthakumar V. Comparison of the clinical performance of the i-gelTM, LMA SupremeTM, and Ambu AuraGainTM in adult patients during general anesthesia: A prospective and randomized study. Korean J Anesthesiol. 2022;75(4):316-322.
17. Sarma R, Kumar R, Kumar NG, et al. Comparative evaluation of Intubating Laryngeal Mask Airway (ILMA), I-gel and Ambu AuraGain for blind tracheal intubation in adults. J Anaesthesiol Clin Pharmacol. 2022;38(1):130-136.
18. Kriege M, Piepho T, Zanker S, Alflen C, Heid F, Noppens RR. LMA SupremeTM and Ambu® AuraGainTM in anesthetized adult patients: A prospective observational study. Minerva Anestesiol. 2016;83(2):165-174.
19. Hernandez MR, Klock Jr PA, Ovassapian A. Evolution of the extraglottic airway: A review of its history, applications, and practical tips for success. Anesth Analg. 2012;114(2):349-368.
20. Taniguchi T, Fujii T, Taniguchi N, Nishiwaki K. Risk factors for postoperative sore throat associated with i-gelTM, a supraglottic airway device. Nagoya J Med Sci. 2022;84(2):319-326.