Effect of immobilised cervical spine on oropharyngeal sealing pressure with Ambu AuraGain™ Supraglottic airway: A randomised crossover trial

Abstract

Background and Aims: Ambu ® AuraGain™ laryngeal airway (AuraGain) is one of the newer supraglottic airway device introduced in 2014. Cervical spine stabilisation with hard cervical collar makes insertion of supraglottic airways and tracheal intubation difficult. This study was conducted to investigate whether the presence of a cervical collar affects the oropharyngeal sealing pressure (OSP) and fibreoptic view of the glottis (Brimacombe score) in airways secured with the AuraGain. Methods: The study was a randomised crossover trial. Thirty five ASA 1-3 patients undergoing elective surgery under general anaesthesia were recruited for the study. In each patient AuraGain was inserted twice in a crossover manner once with and once without a hard cervical collar in situ , with the sequence of insertion randomised. During each insertion of AuraGain the OSP, fibreoptic view of the glottis, insertion parameters, ventilator data and complications were noted. Results: The mean OSPs in both the groups were similar with no significant difference (29.6 ± 3.7 cmH 2 O without collar and 30.1 ± 3.1 cmH 2 O with collar [ P = 0.310]). The fibreoptic view of glottis was also similar in both groups. The insertion with collar was more difficult than without collar. The number of attempts for successful insertion was same in both the groups. The time taken for appropriate placement of LMA was significantly prolonged in patients with collar. Conclusions: We conclude that the Ambu AuraGain can be used to provide effective ventilation in patients whose cervical spine is immobilised with a hard cervical collar.

Airway management in patients with suspected or confirmed cervical spine injury

“…A wide range of supraglottic airway devices (SADs) have been assessed for their impact on cervical spine movement and their performance with cervical spine immobilisation in patients and cadavers. Most first‐ and second‐generation SADs studied perform either equally well or better when cervical spine immobilisation is in place, with little data showing the superiority of one device over another [24–27]. Cervical spine immobilisation, therefore, does not hamper SAD effectiveness in terms of ventilation.…”

The effectiveness of the Ambu® AuraGain™ laryngeal mask on hemodynamic and respiratory parameters in patients undergoing septoplasty: A randomized prospective clinical study

“…A study by Mihara et al [8] on pediatric patients concluded that the i-Gel ® (Intersurgical Ltd., UK, second generation) was easier to place than the Ambu® AuraGain™ and therefore caused less oropharyngeal damage, but lower airway pressures were obtained with the Ambu® AuraGain. Likewise, Uthaman et al [9] found that use of the Ambu® AuraGain™ LMA in patients with an immobilized cervical spine had adequate oropharyngeal leak pressure with a stiff collar. Although studies on the thirdgeneration airway device, the Ambu® AuraGain™ LMA, are more limited, most studies performed with other LMA variants showed that the Ambu® AuraGain™ LMA is equivalent or superior to LMA [7,10,11].…”

Comparison of clinical performance of Ambu® AuraGain™ and BlockBuster® in anaesthetised preschool children-A randomised controlled trial

“…[ 6 ] and Uthaman et al . [ 11 ] have reported the mean ± standard deviation (SD) of OSP with LMA BlockBuster ® and Ambu® AuraGain™ as 33.7 ± 1.8 cm H 2 O and 29.6 ± 3.7 cm H 2 O, respectively, in adult patients. Taking into account the difference in OSP between these two devices to be 4.1 cm H 2 O, we needed to study 17 participants in each of the study groups to be able to reject the null hypothesis that Ambu® AuraGain™ and LMA BlockBuster ® both provide equal seal pressures.…”