Comparison of Oropharyngeal Seal Pressure in Ambu AuraGain vs I-gel among Paediatric Surgery Patients: A Randomised Clinical Study

Abstract

Introduction: The Oropharyngeal Seal Pressure (OSP) achieved by the supraglottic device holds significant importance as it indicates the feasibility of positive pressure ventilation, the degree of airway protection from supra cuff soiling, and also relates to postoperative morbidity. Supraglottic Airway Devices (SADs) have been increasingly used to mitigate the complications of endotracheal intubation. Aim: To compare the OSP in Ambu AuraGain versus I-gel SADs used in young children under general anaesthesia. Materials and Methods: The present randomised, singleblinded, interventional study included 88 patients aged between 1-5 years, weighing 10-30 kg, with American Society of Anaesthesiologists (ASA) Grade-I and II, undergoing elective inguinal and urology procedures under general anaesthesia. The children were randomly allocated to two groups of 44 each. In Group A, Ambu AuraGain was used, while in Group B, I-gel was inserted to secure the airway. The OSP was determined at the time of insertion and 30 minutes after insertion as the primary objective. The secondary objectives included the first attempt success rate, ease of SAD insertion, ease of gastric tube insertion, fiberoptic visibility of the glottic aperture, intraoperative vitals, and any adverse effects. Unpaired t-test was used to compare clinical indicators for quantitative data between the two independent groups. The Chi-square test was used for qualitative data when comparing two or more groups. The level of significance was set at a p-value <0.05. Results: The mean age in group A and group B was 3.45±1.41 years and 3.29±1.16 years, respectively. The mean weight in group A and group B was 15.13±3.67 kg and 14.25±3.18 kg, respectively. The OSP soon after insertion and 30 minutes after insertion was more in group B than group A. The p-values were 0.006 and 0.002, respectively, which were statistically significant. The first attempt success rate was higher in group A (97.7% versus 95.5%), and it was easier to insert with a shorter duration of time (17.70±2.707 versus 18±2.48 seconds). Gastric tube insertion was easier in group B (88.6% versus 84.1%), but the fiberoptic visibility was better in group A (77.3% versus 77.2%). Lesser intraoperative manipulation was required in group A (97.7% versus 93.2%), and the occurrence of postoperative complications was higher in group B. Conclusion: I-gel is better in terms of OSP, while Ambu AuraGain was superior in terms of ease of insertion, better fiberoptic visibility, and fewer postoperative complications.