Airway management is a critical priority for HEMS teams, as failure to secure the airway remains a major determinant of mortality and long-term disability. The present study was designed to evaluate the variability of advanced airway management devices and medications availability across all HEMS units in Italy. In addition, crew composition and specialty training of HEMS personnel were assessed. As a whole, this survey aims at highlighting areas for improvement of airway management during HEMS operations. This observational cross-sectional study was carried out between May and September 2024. A web-based questionnaire was distributed to all active HEMS bases in Italy. The questionnaire consisted of two main sections: Section A addressed the availability of basic and advanced airway management equipment and medications, whereas Section B focused on crew characteristics, including number, role, experience, and training. A composite index to capture "airway preparedness"(API) was designed based on Difficult Airway Society 2025 guidelines. Selected items were assigned a weighted value and the final score ranged 0-40. Of 55 active HEMS bases, 48 completed the questionnaire (response rate: 87%). Manual ventilation devices, a direct laryngoscope, a complete set of Macintosh adult blades, an end-tidal CO₂ monitoring device, and supraglottic airway devices were consistently available. A videolaryngoscope was present in most bases (39, 81%). Either surgical or Seldinger cricothyroidotomy kits were present in 94%. Medications for rapid sequence intubation were universally available, although sugammadex was stocked in only 36 bases (75%). A physician was present in all surveyed units (100%). However, specific training in airway management was not provided in 37 bases (77%), and 44% did not require a minimum number of prior endotracheal intubations for new personnel. Only 13 bases (27%) reported the adoption of airway management guidelines for prehospital care. The mean ± SD national API was 25.7 ± 7.4, ranging from a regional mean of 37 ± 1.4 to a regional mean of 11.2 ± 5.3. The study demonstrated substantial heterogeneity in equipment, personnel background, and training across Italian HEMS bases. Although only few bases reported adherence to specific guidelines, the devices and medications recommended in the literature for the management of unexpected difficult airways were widely available.

Failed tracheal intubation is a high-risk airway event that may rapidly progress to hypoxemia, aspiration, cardiovascular collapse, and the “can’t intubate, can’t oxygenate” scenario when rescue strategies are delayed. This review aimed to synthesize evidence-based approaches for failed intubation management in the operating room and emergency department, emphasizing practical decision-making after the first unsuccessful laryngoscopy. An integrative literature review was conducted using major international guidelines and reference publications, with emphasis on the American Society of Anesthesiologists difficult airway guidelines, Difficult Airway Society algorithms, NAP4 findings, and studies on rescue oxygenation, supraglottic airway devices, videolaryngoscopy, front-of-neck access, and human factors. The evidence supports an oxygenation-centered approach, including early declaration of failed intubation, limitation of repeated attempts, physiological optimization, use of second-generation supraglottic airway devices, appropriate videolaryngoscopy, and timely transition to emergency front-of-neck access when non-invasive oxygenation fails. Human factors, such as task fixation, confirmation bias, communication failures, and delayed escalation, are central contributors to adverse outcomes. Failed intubation management should be implemented through standardized algorithms, cognitive aids, team training, and simulation-based preparation, re inforcing that patient safety depends on maintaining oxygenation rather than pursuing intubation at any cost.

Use, perceptions, and barriers to supraglottic airway devices in Brazil: a national cross-sectional survey with global implications.

Introduction: I-gel®, a second-generation supraglottic airway device with a soft, anatomically shaped cuff, which produces an airway seal without the need for air inflation. Distinctive features of the paediatric airway may interfere with ideal insertion of Supraglottic Airway Devices (SADs). Therefore, it is important to recognise the most effective technique for I-gel® placement in paediatric patients to minimise airway-related complications. Aim: To compare the triple airway manoeuvre and reverse insertion technique for I-gel® placement in paediatric patients under general anaesthesia. Materials and Methods: This single blinded, Randomised Controlled Trial (RCT) was conducted at Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, Haryana, India, over a period of 14 months from July 2023 to September 2024 in 100 paediatric patients (7-12 years), American Society of Anaesthesiologists-Physical Status (ASA-PS) grade I and II of either gender planned for elective surgery. Randomisation was performed into two groups using a computer-generated random number table, with 50 patients in each group. In Group R, I-gel® placement was done using the reverse insertion technique (n=50) and in Group TAM, I-gel® was placed using the triple airway manouvre, i.e. head tilt, jaw thrust, mouth open (n=50). Mean insertion time was measured as the primary outcome. Other parameters studied were the number of attempts, overall success rate, ease of I-gel® insertion, ease of nasogastric tube insertion and postoperative complications. Wilcoxon-Mann-Whitney U test, Chi-squared test, Fisher’sexact test were used to analyse data. A p-value <0.05 was considered statistically significant. Results: The demographic profile of all 100 patients was comparable in both groups, based on age, gender, Body Mass Index (BMI) and ASA-PS classification. The mean±SD of insertion time in group R was 18.65±8.07 sec and in group TAM was 16.84±6.93 sec. The device was successfully placed on the first attempt in 90% of patients in group R compared with 84% in group TAM. The overall success rate was 100% in both groups. Conclusion: TAM and reverse insertion techniques of I-gel® placement were comparable clinically. The experience of the investigator with the technique should determine the choice of technique.

Jiancheng dual-channel vs. i-gel laryngeal mask airway for fiberoptic bronchoscopy: A randomized trial.

Supraglottic airway (SGA) devices are widely used to facilitate ventilation during general anesthesia. However, comparative clinical data on different SGA designs remain limited. This study aimed to compare the placement characteristics, clinical performance, and complication profiles of three SGA devices: I-Gel™, the ProSeal™ LMA, and Tulip® Oropharyngeal Airway. This prospective, observational study included 135 adult patients (ASA I–III) scheduled for elective surgery. Three patients were excluded before device placement, leaving 132 patients for analysis. Device selection was based on routine clinical judgment. Failed placements (n = 17) were included in the analysis of placement success and failure rates but excluded from performance-related outcomes such as insertion time and ease of insertion. The primary outcome was insertion time. Secondary outcomes included number of attempts, need for additional maneuvers, hemodynamic parameters, and perioperative complications. Among 132 evaluated placements, the Tulip device demonstrated a significantly higher failure rate compared with I-Gel and ProSeal (25% vs. 5% and 5%, respectively; p = 0.004). Consequently, performance outcomes were analyzed in 115 successfully ventilated patients (I-Gel n = 38, ProSeal n = 38, Tulip n = 39). The Tulip group required a greater number of insertion attempts (p = 0.002). No significant differences were observed between the groups regarding insertion time, ease of insertion, need for maneuvers, hemodynamic variables, or adverse events (p > 0.05). While ProSeal and I-Gel showed comparable clinical performance, the Tulip airway was associated with a higher rate of unsuccessful placement and required more insertion attempts. These findings suggest that device design and operator familiarity may influence placement success. Larger randomized studies are warranted to confirm these results.

Supraglottic airway devices (SGAs) are essential tools in anesthesia and emergency medicine and are easier to teach than endotracheal intubation. The Singularity Air is a recently introduced second-generation laryngeal mask featuring an adjustable shaft angle to improve sealing. This study compared its bench performance between medical personnel with and without airway management training. In this randomized, controlled in-vitro study, medical personnel each performed five consecutive insertions using the Singularity Air and a comparator device. Study Part A included 20 participants without anesthesia training, who used the LMA Unique. Study Part B included 20 anesthesia-trained staff, who used the Ambu AuraGain. The primary endpoint was time to successful ventilation, defined as visible chest movement of the mannequin. Participants rated insertion difficulty on a 0-10 scale. Overall insertion success was 99-100% across all devices. For the Singularity Air, median time to successful ventilation on the first attempt was 17 seconds (IQR 10-22) in the non-anesthesiology group and 12 seconds (IQR 10-14) in the anesthesia-trained group (P = 0.287). By the fifth attempt, both groups achieved 7.5 seconds (IQR 5-10 and 6-8, respectively; P = 0.674). Time to ventilation and difficulty ratings were low and comparable to the established devices. The non-anesthesiology participants improved more between the first and fifth attempts than anesthesia-trained participants (P = 0.152). The Singularity Air laryngeal mask achieved a high success rate and comparable time to ventilation in an in-vitro study when used by acute care medical personnel, regardless of prior airway management training. Larger clinical studies are warranted to confirm these findings and evaluate performance in real patients.

Despite the frequent use of both advanced airway management (AAM) and epinephrine during resuscitation, no studies have evaluated the optimal sequencing of these interventions in paediatric out-of-hospital cardiac arrest (OHCA). We therefore aimed to investigate the association between the sequence of AAM and epinephrine administration and outcomes in paediatric patients with OHCA with non-shockable rhythms. This retrospective observational study analysed data from a multicentre OHCA registry in Japan from 2014 to 2022. We included paediatric patients (aged <18 years) with non-shockable OHCA who received AAM (endotracheal intubation or supraglottic airway device placement) and/or epinephrine administration. The primary outcome was 1-month survival, and the secondary outcomes were 1-month favourable neurological outcome (defined as a paediatric cerebral performance category of 1-3) and the return of spontaneous circulation (ROSC). Inverse probability of treatment weighting (IPTW) was applied based on propensity scores to address imbalances in patient characteristics. Of the 952 paediatric patients with non-shockable OHCA (median age (IQR) 2 (0-14) years), 577 (61%) were male. Of these, 455 and 497 belonged to the AAM-first and epinephrine-first groups, respectively. After IPTW, all covariates were well balanced between the AAM-first and epinephrine-first groups (standardised mean difference ≤0.10). Compared with the epinephrine-first group, the AAM-first group showed similar 1-month survival (adjusted OR (aOR), 1.09; 95% CI 0.61 to 1.86), favourable neurological outcome at 1 month (aOR, 0.79; 95% CI 0.12 to 5.07) and ROSC (aOR, 0.98; 95% CI 0.72 to 1.35). The sequence of AAM and epinephrine administration was not associated with 1-month survival, favourable neurological outcome at 1 month or ROSC in paediatric patients with non-shockable OHCA.

As lung cancer screening is now covered by statutory health insurance and with the goal of early cancer detection, the number of diagnostic and interventional bronchoscopic procedures is expected to increase substantially - in order to facilitate timely treatment and improve patient survival. This trend underscores the growing importance of evidence-based anaesthesiological management in interventional bronchoscopy.This review summarises current anaesthetic strategies, oxygenation and ventilation techniques, and the monitoring modalities used in interventional bronchoscopy. The review critically appraises the available evidence regarding safety, risk profiles, and procedural outcomes.While diagnostic bronchoscopy is commonly performed under local anaesthesia, with or without moderate sedation to improve patient comfort, modern interventional bronchoscopy imposes significantly higher demands on anaesthetic care. Increasingly complex and invasive procedures, such as transbronchial cryobiopsy, airway stent implantation, and endobronchial tumour ablation, require tailored approaches to analgesia, anaesthesia, airway management, and respiratory support, in order to ensure procedural success and patient safety. The shared airway necessitates close interdisciplinary collaboration and the continuous maintenance of adequate oxygenation and ventilation throughout the intervention.Anaesthetic strategies range from various levels of procedural sedation to general anaesthesia with neuromuscular blockade. Airway management options include augmented spontaneous breathing, supraglottic airway devices, infraglottic techniques such as rigid bronchoscopy, endotracheal tubes, and specialised catheters for jet ventilation. In addition to conventional oxygen supplementation, established respiratory support modalities include high-flow nasal oxygen therapy, controlled mechanical ventilation, and jet ventilation, which may be selected or combined - depending on procedural and patient-specific requirements.Individually adapted anaesthetic concepts are essential for minimising procedural complications and optimising outcomes. This requires structured pre-interventional interdisciplinary evaluation and the implementation of standardised peri-interventional strategies. The choice of anaesthetic technique should be individualised, considering patient-related risk factors, comorbidities, underlying pulmonary pathology, and the type and invasiveness of the bronchoscopic procedure.

With an incidence of 64.9/100,000 inhabitants in Germany, out-of-hospital cardiac arrest is a frequent reason for emergency medical services (EMS) deployment. Advanced airway management is akey part of advanced life support (ALS), enabling adequate ventilation and continuous chest compressions. Video laryngoscopy (VL), which is increasingly being used, is expected to lead to better success rates and shorter interruptions in chest compressions during airway management. Thus, this article focuses on type of airway management and the devices used and how they relate to the likelihood of achieving return of spontaneous circulation (ROSC) and the resulting survival and neurological outcome. Between January 2020 and June 2024, EMS personnel and emergency physicians received questionnaires on airway management of out-of-hospital resuscitations in which they were involved. The data were supplemented by emergency protocols and defibrillator recordings. The analysis was conducted descriptively and statistically at a significance level of α ≤ 0.05. A total of 301questionnaires were assessed: 35% of patients who received endotracheal intubation (ETI) achieved ROSC compared with 21.1% with the use of a supraglottic airway device (SGA; p = 0.09). With the McGrath VL, the ROSC rate was 43.6%, compared to 33.3% with the C‑MAC (p = 0.24). Following 1-2 intubation attempts, ROSC was achieved in 33.8% of cases, and in 28.6% of cases after more than two attempts. The survival rate was 9.1% after ETI and 2.6% after SGA (p = 0.17). With VL, 10.9% of patients survived, 64.7% with a good neurological outcome (cerebral performance category [CPC] 1-2). With direct laryngoscopy, 6.1% survived, 57.1% with CPC 1-2 (p = 0.19/p = 0.73). The results show apotential advantage of video laryngoscopy for endotracheal intubation, whereby > 2 intubation attempts are associated with poorer outcomes. Significant effects on ROSC, survival or an improved neurological outcome were not observed. Larger studies are necessary to verify the results. Increased use of video laryngoscopy could be beneficial regardless of the user.

The development of second-generation supraglottic airway devices in clinical practice has led to a progressively growing trend wherein supraglottic airway devices are favoured instead of tracheal intubation for airway management in laparoscopic surgeries. The clinical advantages of two large-volume gastric drainage channels to prevent aspiration and an integrated cuff pressure indicator called the Cuff pilot™ for application of higher respiratory pressure have resulted in the Laryngeal Mask Airway Protector™ rising in popularity. There are limited studies for the use of this device in obese patients. We describe our initial experiences with the use of the Laryngeal Mask Airway Protector in ten obese patients undergoing laparoscopic cholecystectomies at a tertiary care centre in India. In all patients, we found the Laryngeal Mask Airway Protector to have good first-attempt successful device placement, higher oropharyngeal leak or sealing pressures, adequate ventilation, excellent fibreoptic glottic views, and improved gastric drainage. This case series demonstrates that the Laryngeal Mask Airway Protector may be a safe and acceptable alternative for moderately obese patients when used by a clinically experienced anaesthetist.

This study examines the influence of supraglottic airway (SGA) devices versus tracheal intubation (TI) on key ventilation parameters during intra-arrest-ventilation using volume-controlled-ventilation (VCV) in adult out-of-hospital cardiac arrest (OHCA). This cohort study is based on real-world data obtained from the emergency medical service of the Gütersloh district, Germany. Ventilation data were extracted in March 2024 from emergency ventilators and combined with patient-level information from the German Resuscitation Registry. Adult OHCA cases receiving intra-arrest-ventilation 01/2019-08/2023 with VCV via either SGA or TI were included. Collected parameters included the airway device used, set tidal volume (VTset), measured expiratory tidal volume (VTe), and leakage volume (VLeak). The primary outcome was the difference between VTset-VTe. Patients were grouped according to the airway management strategy used (SGA vs. TI). Potential differences in outcomes between these groups were assessed using linear mixed regression models. VCV was performed in n=27 individuals (682min) using SGA in n=13 (330min) vs. TI in n=14 (352min). The mean total VTset was 562.8±58.0ml (TI=573.9±62.5ml; SGA=550.9±50.1ml). The mean VTe totaled 270.7±205.5ml (TI=348.1±215.6ml; SGA=188.2±156.6ml). The mean VLeak was 23.3±27.4% (TI=5.5±7.0%; SGA=42.3±28.4%). Compared to SGA, TI was associated with smaller VTset-VTe (regression coefficient: -128.3ml; 95%-CI: [-252.3ml; -4.3ml]; p=0.0427) as well as for a lower VLeak (regression coefficient: -32.3%; 95%-CI: [-46.1%; -18.4%]; p<0.0001) for TI. In OHCA cases receiving mechanical intra-arrest-ventilation with VCV, TI was associated with higher delivered VTe, less deviation from VTset, and significantly lower VLeak compared to SGA.

High-dimensional single-cell analysis evaluating effects of different airway management strategies on perioperative immune cells in non-small cell lung cancer surgery.

Pulmonary complications following postpartum tubal ligation with laryngeal mask vs. endotracheal intubation: a retrospective cohort study (2012-2024).

Introduction: Blind insertion of Supraglottic Airway Devices (SAD) often results in suboptimal positioning in the oropharynx or hypopharynx. On the other hand, laryngoscopy-guided insertion will give a better One-Lung Ventilation (OLV) and prevention of aspiration. A limited number of studies have been done to compare this blind and videolaryngoscopic positioning of a new device, Ambu® AuraGain™, which is a single-use, anatomically curved device with intubation capabilities. Aim: To compare videolaryngoscopy-guided insertion with the blind paramedian insertion technique of Ambu® AuraGain™ for the efficacy of ventilation. Materials and Methods: This Randomised Controlled Trial (RCT) was conducted at Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, over a period of 18 months (July 2022 – December 2023) in 100 patients in a tertiary care centre of a tier one city. At the end of 5 minutes and 30 minutes after device insertion, oropharyngeal leak pressure was measured as the primary outcome of the study. Randomisation was done into two groups (B and V). Group B was taken as the control group and group V was the test group, where the videolaryngoscopic-guided insertion of the device was done. Other parameters studied were successful attempts, ease of insertion and passage of the gastric catheter. Independent t-test, Chi-Square test, Fisher‘s-exact test and Statistical Package for Social Sciences (SPSS) 25.0 were used to analyse data. For statistical significance, a p-value of less than 0.05 was considered statistically significant. Results: The demographic profile of all 100 patients was comparable in both groups, based on age, gender, American Society of Anaesthesiologists Physical Status (ASA) classification, and Body Mass Index (BMI). C-MAC® videolaryngoscopyguided technique of insertion of Ambu Aura Gain provides better efficacy of ventilation in terms of higher Oropharyngeal Leak Pressure (OLP) as compared to the blind paramedian insertion technique in adult patients undergoing elective surgery under General Anaesthesia (GA). The mean oropharyngeal leak pressure (cm of H2 O) at 5 minutes and 30 minutes post device insertion in group V and group B was 37.14±1.77 vs. 34.20±1.68 and 37.9±1.61 vs. 35.2±1.54, respectively. Time taken for effective ventilation was more in the C-MAC® group (34.64±0.98 sec vs. 27.18±1.35 sec, respectively). Conclusion: C-MAC® videolaryngoscopy-guided technique of insertion of Ambu® AuraGain™ provides better efficacy of ventilation in terms of higher oropharyngeal leak pressure as compared to the blind paramedian insertion technique in adult patients undergoing elective surgery under GA.

Background and aimsThe increasing use of supraglottic airway devices has led to a shift in airway management practices. BlockBuster® Laryngeal Mask Airway (BLMA; Henan Tuoren Medical Device Co., Ltd., China) is a newer second-generation device, and its use in prolonged surgeries remains limited. Off-pump cardiothoracic surgeries are conventionally performed using endotracheal intubation, which may be associated with significant haemodynamic responses.MethodsThis prospective randomized study included 60 adult patients undergoing elective off-pump cardiothoracic surgeries, allocated into two groups of 30 each. Group A had the airway secured using a Blockbuster LMA, and Group B used an endotracheal tube. Time taken to achieve an effective airway, number of attempts, ease of insertion, intraoperative haemodynamic and ventilatory parameters, and post-operative complications were assessed.ResultsThe time taken to achieve effective airway was significantly shorter in Group A compared to Group B (p<0.001). Haemodynamic parameters including heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure were significantly higher in Group B during the immediate period following airway securement (p<0.05). The incidence of post-operative sore throat was significantly higher in the endotracheal tube group (p<0.05). Ventilatory parameters were comparable between the two groups.ConclusionBlockbuster LMA is a suitable alternative to the endotracheal tube for airway management in patients undergoing off-pump cardiothoracic surgery, providing quicker airway establishment, better haemodynamic stability, effective ventilation, and fewer post-operative complications.

More than 300 million major surgical procedures are carried out under general anaesthesia each year worldwide, and advanced airway management remains one of the leading daily challenges for clinicians. Data from large international prospective cohort studies on adverse events such as cardiovascular collapse, cardiac arrest and severe hypoxaemia during advanced airway management to facilitate anaesthesia are lacking. The International obServational sTudy on AiRway manaGement in operAting room and non-operaTing room anaEsthesia (STARGATE) study will be an international prospective observational cohort study describing the incidence of major adverse events associated with advanced airway management (tracheal intubation or supraglottic airway device placement) for general anaesthesia in the operating and non-operating room for surgery and medical procedures. The secondary aim will be to describe the practice of airway management in a large international cohort. Critically ill patients will be excluded from this study. Data on patients' characteristics, type of procedure and the adopted airway management strategy, post-procedure adverse events, operator characteristics and in-hospital mortality will be prospectively collected. The study aims to enrol 10 500 patients. The study has been approved by the Ethics Committee of the coordinating centre (Comitato Etico Interaziendale AOU San Luigi Gonzaga, N° 25/2023). Each of the participating centres will then seek approval of their local Ethics Committee before enrolment. Data will be disseminated to the scientific community by original articles submitted to international peer-reviewed journals. NCT05759299.

Objective: Supraglottic airway devices are pivotal tools for airway management in anesthesia. The I-gel, a widely used second-generation airway device, is recognized for ease of insertion and low complication rate. This study aims to compare the ease of insertion of I-gel and associated insertion conditions when used with Fentanyl and Dexmedetomidine in combination with Propofol. Methods: After obtaining approval of ethical committee, a total of 60 patients were enrolled a tertiary care hospital and divided into two groups. Group F received 2 mcg/kg of intravenous fentanyl and propofol; Group D received 1 mcg/kg of intravenous dexmedetomidine infusion in 10 minutes and propofol. The ease of I-gel insertion and jaw relaxation was assessed using the modified Lund and Stovener criteria and Young’s criteria, respectively. The physiologic variables, adverse events like apnea, desaturation, cough, jaw movement; and additional requirement of propofol bolus doses were recorded at baseline, first, third, fifth and tenth minutes after insertion. Results: No significant differences were observed in jaw relaxation, ease of I-gel insertion, and adverse events. The apnea duration was shorter in Group D (12.1±2.3 min vs 15.1±2.8, p&lt;0.001). Respiratory rate was significantly lower in Group F. It was easier to insert I-gel in Group D (p=0.213). Ramsay Score was higher and Aldrete score was lower in Group D (p&lt;0.001). Conclusion: Dexmedetomidine as an adjuvant to propofol is a safe alternative to combination of propofol and fentanyl in pediatric surgeries. Although both drugs maintain a stable hemodynamic profile, dexmedetomidine demonstrates superior efficacy in preserving respiratory stimulus.

Background: Laparoscopic surgeries are being used more commonly than ever before for a wide variety of procedures because of the advantages they offer over conventional open surgeries. Similarly, supraglottic airway devices (SADs) provide several benefits over endotracheal intubation, including ease of insertion, reduced hemodynamic changes, and less airway manipulation, making them an attractive alternative in appropriate laparoscopic procedures. Methods: A prospective study which includes 60 ASA 1 &amp; 2 patients belonging to 18-65 years of age groups. They were randomly allocated into 2 groups. Group LMA P; where LMA protractor was used in anesthetised and non-paralysed patients. Group BM; where buska mask was used in anesthetised and non-paralysed patients. The primary objectives of the study was ease of insertion of SAD (number of attempts), Oropharyngeal leak pressure (in cms of H2O), secondary objectives-Time taken for insertion, Volume of air to achieve the intracuff pressure of 60cms of water (in ml in protector), Vocal cord visibility under fiberoptic scope, Successful gastric tube insertion, adverse effects like blood stained on airway device sore throat and dysphagia. Results: the mean duration of LMA insertion in Group LMA P (12.93 + 3.26, P&gt;0.05), in Group BM (13.00 + 4.46, P&gt;0.05). The mean OLP in group LMA P was 32.83+ 3.29, whereas mean OLP of group BM was 31.70+3.96(P&gt; 0.05). Conclusion: We have concluded that both SADs have similar functional efficacy, in laparoscopic surgeries.

Background and Aim: Second and third-generation supraglottic airway devices (SADs) are increasingly used in laparoscopic surgeries due to their improved oropharyngeal seal and gastric drainage.This study evaluated and compared the clinical efficacy of the Ambu AuraGain (AAU) and the i-gel in patients undergoing laparoscopic cholecystectomy.Materials and Methods: In this prospective, randomized comparative study, 80 adult patients (ASA I and II) were randomly assigned to two groups (n=40 each): Group A (Ambu AuraGain) and Group G (i-gel).The primary objective was to compare oropharyngeal leak pressure (OLP).Secondary objectives included insertion time, ease of insertion, success rate, fiberoptic view of the glottis, and postoperative complications.OLP and peak airway pressure (PAP) were measured at various intervals, including during carboperitoneum.Results: The mean OLP was significantly higher in Group A than in Group G, both after insertion (32.9 3.45 vs. 26.53 1.61 cm H2O; p<0.001) and after deflation of carboperitoneum (34.15 2.9 vs. 28.21.71 cm H2O; p<0.001).The margin of safety (OLP-PAP) was significantly higher in the AAU group at all times (p<0.001).However, the i-gel was significantly faster to insert (14.8 2.94 vs. 22 3.74 seconds; p<0.001) and easier to place (100% easy vs. 37.5% easy; p<0.001).Fiberoptic alignment was significantly better in the i-gel group, with 70% achieving a Grade 4 view compared to 29% in the AAU group (p<0.001).Postoperative complications were low and comparable between groups.Conclusion: Ambu AuraGain provides a superior oropharyngeal seal and a higher safety margin against leaks during laparoscopic surgery compared to i-gel.Conversely, i-gel is superior in terms of ease of insertion, speed, and anatomical alignment with the glottis, making it a better conduit for fiberoptic-guided intubation.