title: 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 H2O. 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 H2O 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.
authors.affiliation: Department of Anesthesiology, Hospital Clinic de Barcelona, Faculty of Medicine, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain. analopez@clinic.ub.es.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Lopez
authors.affiliation: Department of Anesthesiology, Hospital Clinic de Barcelona, Faculty of Medicine, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
authors.forename: Merce
authors.initials: M
authors.lastname: Agusti
authors.affiliation: Department of Anesthesiology, Hospital Clinic de Barcelona, Faculty of Medicine, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Gambus
authors.affiliation: Department of Anesthesiology, Hospital Clinic de Barcelona, Faculty of Medicine, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Pons
authors.affiliation: Department of Anesthesiology, Hospital Clinic de Barcelona, Faculty of Medicine, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Anglada
authors.affiliation: Department of Anesthesiology, Hospital Clinic de Barcelona, Faculty of Medicine, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
authors.forename: Ricard
authors.initials: R
authors.lastname: Valero
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058109:Airway Management / Q000295:instrumentation*; D000768:Anesthesia, General; D004867:Equipment Design; D005260:Female; D005931:Glottis / Q000502:physiology; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation; D010535:Laparoscopy; D017214:Laryngeal Masks; D008875:Middle Aged; D056888:Patient Positioning; D012119:Respiration; D016896:Treatment Outcome; D055815:Young Adult
keywords: Airway management; Laparoscopy; Supraglottic devices