Comparison of i-gel®, Ambu® AuraGain™, Baska Mask, LMA® Protector™ for airway management of obese surgical patients - A randomised comparative study.

Abstract

Background and aims: A few trials have studied the use of supraglottic airway devices (SADs) for obese patients. This trial aimed to compare four SADs: I-gel, Ambu AuraGain, Baska mask, and Laryngeal Mask Airway (LMA) Protector for airway management of obese patients.

Methods: This parallel-group, single-blind, comparative randomised study included 154 obese patients aged between 18 and 60 years who were planned for elective surgery. They were randomly allocated one of the above four SADs for airway management. Each group had 38 patients. The allocated SAD was inserted after induction of anaesthesia. oropharyngeal leak pressure (OLP) was the primary outcome. Data were analysed using analysis of variance, Kruskal-Wallis, or χ² test.

Results: Baseline data of the patients were comparable. Mean OLP was highest with the Baska mask and lowest with the LMA Protector [32.97 (standard deviation (SD): 1.30) (95% confidence interval (CI): 32.54, 33.40] vs 30.08 (SD: 1.51) (95% CI: 29.58, 30.58) cm H₂O). The mean leak fraction was highest with the Baska mask and lowest with Ambu AuraGain (6.88 (SD: 1.33) (95% CI: 6.44, 7.31) vs 6.08 (SD: 1.18) (95% CI: 5.69, 6.47)). The mean time taken to insert the SAD was shortest with I-gel and longest with Ambu AuraGain (18.58 (SD: 1.97) (95% CI: 17.93, 19.23) vs 29.11 (SD: 2.50) (95% CI: 28.28, 29.93) sec). Heart rate, SAD placement success rate, fibreoptic view of the glottis, blood pressure, and side effects were comparable amongst the devices.

Conclusion: For obese patients undergoing elective surgery, the Baska mask has the highest OLP, but I-gel, Ambu AuraGain, and LMA Protector are also acceptable choices.