Comparison of the i-gel™ with the AuraGain™ laryngeal mask airways in patients with a simulated cervical immobilization: a randomized controlled trial

BACKGROUND: The use of second generation supraglottic airway devices is recommended for airway rescue in failed tracheal intubation. This study was performed to compare the clinical performance of the i-gel (TM) with that of the AuraGain (TM) in patients with simulated cervical immobilization. METHODS: We conducted a prospective, randomized controlled trial in 104 patients undergoing general anesthesia from June to September 2018 at the Seoul National University Hospital. Patients were randomly allocated to receive either the i-gel (TM) or the AuraGain (TM) device. A difficult airway was simulated using a cervical collar limiting the mouth opening and neck movement. The primary outcome was the initial oropharyngeal leak pressure. RESULTS: The rate of successful insertion at the first attempt was 92.3% for the i-gel (TM) and 86% for the AuraGain (TM). There were no significant differences in the initial and 5-min ompharyngeal leak pressures between the i-gel (TM) and the AuraGain (TM) (21 +/- 4 vs. 22 +/- 5 cmH(2)O, P=0.229; and 22 +/- 5 vs. 23 +/- 5 cmH(2)O, P=0.308, respectively). The time to successful device insertion was shorter (20 [16-23] vs. 25 [20-41]s. P<0.001) and device insertion was easier (P<0.001) in the i-gel (TM) group than in the AuraGain (TM) group. The blood staining of the device was more frequently observed in the AuraGain (TM) (3 [5.8%] vs. 12 [23.5%] patients, P=0.003). CONCLUSIONS: The i-gel (TM) and the AuraGain (TM) showed comparable orophamyngeal leak pressures and success rates in the first attempt in patients with simulated cervical immobilization. However, the i-gel (TM) was easier to insert and required less time for insertion than the AuraGain (TM).