Comparison of Brimacombe score and first-attempt success rate of intubation through Ambu AuraGain and i-gel in anaesthetized adult patients: A prospective open-label study.

Background and Aims: Second-generation supraglottic airway devices (SAD), such as i-gel and Ambu AuraGain, offer higher sealing pressures and facilitate intubation. Although literature exists on their ventilatory characteristics, limited data are available on their performance as intubation conduits in the adult Indian population. The purpose of this study was to shed light on the clinical performance and intubation characteristics of both devices. Material and Methods: In this prospective, open-label study, 96 ASA I and II patients aged 18-60 years undergoing elective surgeries were equally randomized into Group A (Ambu AuraGain) and Group I (i-gel). All SADs were inserted under general anaesthesia using standard techniques. Outcomes included the Brimacombe score (primary), first-attempt success rate of SAD insertion, oropharyngeal leak pressure (OLP), ease of gastric tube insertion, success rate of intubation through SAD, intubation time, size of the endotracheal tube used, ease of intubation, and adverse events. Results: Ambu AuraGain exhibited a superior Brimacombe score when assessed via fibreoptic bronchoscope (P = 0.001), despite necessitating more attempts to achieve successful ventilation. No significant disparities were detected regarding OLP or gastric tube insertion. When evaluating intubation characteristics, the time required for intubation was similar; however, the success rate of intubation and ease of intubation favoured the AuraGain. AuraGain accommodated larger endotracheal tubes with ease. Adverse events, including minor mucosal injuries, were comparable between the two devices. Conclusions: I-gel and Ambu AuraGain demonstrated similar effectiveness in ventilation characteristics. However, Ambu AuraGain facilitated easier endotracheal intubation via SAD in anesthetized adults, owing to its ability to accommodate larger endotracheal tubes compared to i-gel.