Sir,
Ambu AuraGain™[1] is a new single-use supraglottic airway (SGA) device available in adult size 3, 4, and 5. It is an anatomically curved SGA with integrated gastric access and can be used as a conduit for direct endotracheal intubation assisted by a flexible scope.[1] The standard recommended insertion technique is as that of intubating laryngeal mask airway (LMA),[2] i.e., keeping the handle (Shaft) approximately parallel to the patient's chest and then pushing the device along the hard palate after opening the mouth [Figure 1a]. With the previous experience of other faculty and residents with this device in our institute, we noticed that a higher tangential force is required for the placement due to bulky and acute angle of the device. Due to difficulty in insertion, few cases also resulted in oral mucosal injury in the form of bleeding and ulceration with inadequate sealing and higher airway pressure.
Figure 1.
Ambu AuraGain™ (a: Standard recommended insertion, b: Modified insertion technique)
One of the advantages of Ambu AuraGain laryngeal airway is that it can be straightened to that like that of Classic or ProSeal LMA [Figure 1b].[2] We found that the guiding with the tip of the finger as that of classical LMA is more easy and convenient and required minimal pressure to overcome the resistance of the hard palate and posterior pharyngeal wall. After insertion with this technique, we are getting an effective oropharyngeal seal with a leak airway pressure of 25–30 cm of H2O and peak airway pressure and tidal exchange within normal limit for the patient. At present, various studies are going on with this device in our institute where we prefer this method of insertion of this device compare to the conventional technique. Therefore, we advocate using this method routinely and in situations when there is difficulty in placement of this device.
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Conflicts of interest
There are no conflicts of interest.
REFERENCES
- 1.Lopez A, Sala-Blanch X, Valero R, Prats A. Cross-over assessment of the Ambu AuraGain, LMA Supreme New Cuff and Intersurgical I-Gel in fresh cadavers. Open J Anesthesiol. 2014;4:332–9. [Google Scholar]
- 2.Brain AI, Verghese C, Addy EV, Kapila A. The intubating laryngeal mask. I: Development of a new device for intubation of the trachea. Br J Anaesth. 1997;79:699–703. doi: 10.1093/bja/79.6.699. [DOI] [PubMed] [Google Scholar]