Comparative Evaluation of Placement of Auragain, ProSeal and Protector Laryngeal Mask Airways using Fiberoptic Bronchoscopy: A Randomised Clinical Study

Introduction: Supraglottic Airway Devices (SAD) can be used instead of endotracheal intubation in both regular and complicated airway situations. Auragain, ProSeal and Protector Laryngeal Mask Airways (LMA) are second generation LMAs. They have a separate provision for gastric drainage. Auragain LMA is a recent second-generation Supra Glottic Airway device (SGA) with a pre-formed curved shaft and a double lumen having wider airway path to aid endotracheal intubation. ProSeal LMA also has a double cuff for better sealing to prevent gastric insufflation and aspiration. Protector LMA has two large-volume gastric drainage channels and an integrated cuff pressure indicator called the cuff pilot which enables application of higher respiratory pressure. Aim: To compare the adequacy of placement of Auragain, ProSeal and protector LMAs by vocal cord visualisation using fiberoptic bronchoscopy. Materials and Methods: A randomised clinical study was conducted in the Department of Anaesthesiology, SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India, from October 2021 to October 2022 among 120 patients. They were allocated by computer-generated random numbers into three groups namely Auragain, ProSeal and Protector LMA Group. The adequacy of placement of LMA through Fiberoptic Bronchoscopy (FOB) using Brimacombe and berry scoring, Oropharyngeal Leak Pressure (OLP), time of insertion of LMA, number of attempts for insertion, ease of insertion of LMA, Ryle’s tube insertion success rate and postoperative complications were recorded immediately, after an hour and 24 hour, respectively. Statistical analysis was performed using International Business Machines-Statistical Package for the Social Sciences (IBM-SPSS) software version 21.0. Results: The mean±Standard Deviation (SD) age in Auragain groups, ProSeal and Protector LMA groups was 41.35±12.96 years, 36.58±12.62 years and 36.65±12.50 years, respectively. The demographic data, procedures and duration of anaesthesia were comparable between the three groups. The mean insertion time (in seconds) was lower in the Auragain LMA group (16.80±3.66) when compared to protector LMA (20.20±6.93) and ProSeal LMA (21.68±4.44) with statistically significant difference (p-value<0.0001). The OLP (in cm H2O) was more with ProSeal LMA (34.43±5.26) than Protector LMA (32.60±3.45) and Auragain LMA (28.55±1.85) with statistically significant difference (p-value<0.0001). The fiberoptic view was better with ProSeal LMA and statistically significant with Grade 4 (p-value<0.0001) and Grade 3 (p-value=0.007). The three devices were comparable in terms of ease and success of insertion of LMA, ease of placement of gastric tube and postoperative symptoms. Conclusion: It can be concluded that the ProSeal LMA offers better airway access and safety despite being slightly difficult to insert compared to Ambu Auragain or Protector LMA