Ambu® Aura Gain™ versus Ambu® Aura Once™ in children: a randomized, crossover study assessing oropharyngeal leak pressure and fibreoptic position

  • Birgit Stögermüller
  • Sigrid Ofner
  • Bernhard Ziegler
  • Christian Keller
  • Berthold Moser
  • Lukas GasteigerEmail author
Reports of Original Investigations



The Ambu® Aura Gain™ is a new second-generation supraglottic airway device that—because of a wider curvature and a wide airway tube—allows fibreoptic intubation. The purpose of this study was to assess the oropharyngeal leak pressure of the Ambu® Aura GainTM compared with the Ambu® Aura Once™.


In this randomized non-blinded crossover trial with 50 patients aged 18 months to six years (10–20 kg), we compared the Ambu® Aura Gain™ and the Ambu® Aura Once™ for airway maintenance in anesthetized, non-paralyzed participants. Our primary outcome was oropharyngeal leak pressure. Time of insertion, success rates for each device, evaluation of fibreoptic view and ventilation quality during anesthesia, as well as possible complications (e.g., blood staining) were assessed.


There were no differences in first and overall insertion attempt rates (Ambu® Aura Once™ 50/50 (100%) vs Ambu® Aura Gain™ 50/50 (100%). Mean (standard deviation) oropharyngeal leak pressure was found to be significantly higher for Ambu® Aura Gain™ than it was for Ambu® Aura Once™ [21 (7) vs 19 (6) cmH2O, respectively; mean difference [MD] − 2 cmH2O; 95% confidence interval [CI], − 3.8 to − 1.0; P = 0.001]. Mean (SD) insertion time was faster for Ambu® Aura Once™ than for Ambu® Aura Gain™ [8 (3) vs 10 (4) seconds, respectively; MD, − 2 sec; 95% CI, − 2.9 to − 1.2; P < 0.001]. There were no differences in ventilation quality, fibreoptic view, or blood staining.


We conclude that Ambu® Aura Gain™ is a good alternative to the Ambu® Aura Once™ and an efficient device for children in this age group.

Trial registration (NCT02811042). Registered 23 June 2016.

Ambu® Aura Gain™ versus Ambu® Aura Once™ chez des enfants : une étude randomisée à groupes croisés évaluant la pression de fuite oropharyngée et la vision au fibroscope



L’Ambu® Aura Gain™ est un nouveau dispositif supraglottique des voies respiratoires de deuxième génération qui, grâce à une plus grande courbure et à une grande ouverture de la lumière, permet l’intubation au fibroscope. L’objectif de cette étude était d’évaluer la pression de fuite oropharyngée de l’Ambu® Aura GainTM comparée à celle de l’Ambu® Aura Once™.


Dans cette étude randomisée, sans insu, à groupes croisés, ayant inclus 50 patients âgés de 18 mois à 6 ans (10 à 20 kg), nous avons comparé l’Ambu® Aura Gain™ et l’Ambu® Aura Once™ pour le maintien des voies aériennes chez des enfants anesthésiés, non paralysés. Notre critère d’évaluation principal était la pression de fuite oropharyngée. La rapidité d’insertion, le taux de succès pour chaque dispositif, l’évaluation de la visualisation au fibroscope et la qualité de la ventilation au cours de l’anesthésie, ainsi que les possibles complications (p. ex., présence de sang) ont été évalués.


Il n’y a pas eu de différence sur les taux de succès de la première tentative d’insertion ou du taux global d’insertion (Ambu® Aura Once™, 50/50 [100 %] contre Ambu® Aura Gain™ 50/50 [100 %]). La pression de fuite oropharyngée moyenne (écart type) a été significativement plus élevée pour l’Ambu® Aura Gain™ que pour l’Ambu® Aura Once™ (respectivement, 21 [7] contre 19 [6] cmH2O; différence des moyennes [DM], − 2 cmH2O; intervalle de confiance [IC] à 95 % : − 3,8 à − 1,0; P < 0,001). Le temps d’insertion moyen (ET) était plus court avec l’Ambu® Aura Once™ qu’avec l’Ambu® Aura Gain™ (respectivement, 8 [3] secondes contre 10 [4] secondes; DM, − 2 s; IC à 95 %, − 2,9 à − 1,2; P < 0,001). Il n’y a pas eu de différence pour la qualité de la ventilation, la vue endoscopique ou la présence de sang.


Nous concluons que l’Ambu® Aura Gain™ constitue une bonne option de remplacement pour l’Ambu® Aura Once™ et est un dispositif efficace chez les enfants du groupe d’âge étudié.

Enregistrement de l’essai clinique (NCT02811042). Enregistré le 23 juin 2016.


Conflict of interest

Christian Keller consulted for laryngeal mask company.

Editorial responsibility

This submission was handled by Dr. Philip M. Jones, Associate Editor, Canadian Journal of Anesthesia.

Author contributions

Birgit Stögermüller contributed to the conception and design of the study as well as the acquisition, analysis, and interpretation of data. Sigrid Ofner and Bernhard Ziegler contributed to data acquisition. Christian Keller contributed to data analysis and interpretation as well as conception and design of the manuscript. Berthold Moser contributed to data interpretation. Lukas Gasteiger contributed to all aspects of manuscript preparation, including study conception, study design, data analysis, data interpretation, and drafting the article.


This project was supported only by departmental resources.


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Copyright information

© Canadian Anesthesiologists' Society 2018

Authors and Affiliations

  1. 1.Department of Anaesthesia and Intensive Care MedicineParacelsus Medical UniversitySalzburgAustria
  2. 2.Department of Anaesthesia and Intensive CareGeneral Hospital SchwazSchwazAustria
  3. 3.Department of AnaesthesiaSchulthess KlinikZurichSwitzerland
  4. 4.Department of Anaesthesia and Intensive CareMedical University of InnsbruckInnsbruckAustria

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