Clinical Efficacy of Ambu AuraGainTM and i-gel® in Patients Undergoing Elective Gynaecological Laparoscopic Surgeries Under General Anaesthesia: A Randomised Clinical Study

Abstract

Introduction: Second-generation supraglottic airway devices that provide high seal pressures are found to be suitable for patients undergoing laparoscopic surgery, as they have a separate port for gastric tube insertion, effectively separating the airway and the oesophagus. The present study compares the usage of two such second-generation supraglottic devices-AuraGain™ and i-gel® in patients undergoing gynaecological laparoscopic surgeries. Aim: To compare the Oropharyngeal Leak Pressure (OLP) and airway pressures achieved by the i-gel® and Ambu AuraGain™ after insertion in the supine position and during laparoscopic carbon dioxide peritoneum in the Trendelenburg position. Materials and Methods: This randomised clinical, singleblinded study conducted at the Department of Anaesthesiology, Narayana Medical College, Nellore, Andhra pradesh, India involved 100 female patients undergoing elective gynaecological laparoscopic surgeries under general anaesthesia with controlled ventilation. The primary objective was to compare the clinical performance of Ambu AuraGain™ (Group-A) and i-gel® (Group-I) concerning their oropharyngeal seal pressures and airway pressures in gynaecological laparoscopic surgeries. The secondary outcomes measured included the time taken for insertion, ease of insertion of the device, effects on postinsertion haemodynamic parameters like heart rate, blood pressure, oxygen saturation, ease of gastric tube insertion, and fibreoptic bronchoscopic grading of the visualised glottic structures after device placement, as well as postoperative side effects like blood staining upon removal of the device and sore throat. Data were analysed using Student’s t-test and chi-square test. Results: The mean age in Group-A was 39.62±4.085 years, and in Group-I, it was 39.48±2.468 years. The mean peak inspiratory pressures after device insertion were 14.34 mmHg in Group-A and 16.66 mmHg in Group-I. Haemodynamic parameters postinsertion were similar in both groups {Group-A: Mean Heart Rate (HR) 87.22 bpm, Mean Arterial Pressure (MAP) 89.72 mmHg, Oxygen Saturation (SpO2 ) 99.58%; Group-I: Mean HR 87.50 bpm, MAP 89.72 mmHg, SpO2 99.72%). Fibreoptic bronchoscopic grading in Group-A was 0/0/9/41, and in Group-I, it was 0/0/11/39. Blood staining upon removal was noted in four patients (8%) in Group-A and in 3 patients (6%) in Group-I. Sore throat in the postoperative period was noted in 14% of patients in Group-A and 8% in Group-I. Conclusion: Ambu AuraGain™ was found to provide a better seal and higher OLP compared to the i-gel® in gynaecological laparoscopic surgeries and therefore provide safer and more effective ventilation for patients undergoing such surgeries. I-gel® was found to be easier and quicker to insert than the AuraGain™.