Comparison of oropharyngeal leak pressure between the Ambu® AuraGain™ and the LMA® Supreme™ supraglottic airways: a randomized-controlled trial

  • David T. Wong
  • Alister Ooi
  • Kawal P. Singh
  • Amelie Dallaire
  • Vina Meliana
  • Jason Lau
  • Frances Chung
  • Mandeep Singh
  • Jean Wong
Reports of Original Investigations



Studies comparing the recently introduced Ambu® AuraGain™ (Auragain) with the LMA® Supreme™ (Supreme) supraglottic airway (SGA) have reported conflicting results regarding differences in oropharyngeal leak pressure (OLP). This randomized-controlled trial investigated the OLP of the Auragain compared with the Supreme in patients undergoing ambulatory surgery.


Adult patients with a body mass index ≤ 40 kg·m−2 presenting for ambulatory surgery and requiring an SGA were randomized to receive either the Auragain or the Supreme. Anesthesia was induced with lidocaine (1 mg·kg−1), fentanyl (1-2 μg·kg−1), and propofol (2-3 mg·kg−1). The SGA was inserted using a standard technique with the cuff inflated to 60 cmH2O. The groups were compared for the primary outcome of OLP.


One hundred sixty-five patients (n = 81, Auragain; n = 84, Supreme) completed the study. Demographics were similar between the groups. The mean (standard deviation [SD]) OLP was significantly higher in the Auragain than in the Supreme group [26.4 (2.8) cmH2O vs 21.6 (3.4) cmH2O, respectively; difference in means (MD), 4.8 cmH2O; 95% confidence interval (CI), 3.9 to 5.8; P < 0.001]. The mean (SD) insertion time was longer in the Auragain than in the Supreme group [13 (4) sec vs 11 (3) sec, respectively; MD, 2 sec; 95% CI, 1 to 3 sec; P < 0.001].


In patients undergoing ambulatory anesthesia, the OLP was higher but took longer to insert with the Auragain than with the Supreme. A higher OLP may allow for SGAs to be utilized in a wider range of patients and procedures.

Trial registration (NCT02816463). Registered 28 June 2016.

Comparaison des pressions de fuite oropharyngée entre les masques laryngés Ambu® AuraGain™ et LMA® Supreme™: essai randomisé contrôlé



Des études comparant les voies respiratoires supraglottiques (SGA) Ambu® AuraGain™ (Auragain) nouvellement commercialisé et LMA® Supreme™ (Supreme) ont fourni des résultats contradictoires concernant les différences de pressions de fuite oropharyngée (OLP). Cet essai randomisé contrôlé a étudié l’OLP de l’Auragain comparativement à celle du Supreme chez des patients subissant une chirurgie ambulatoire.


Des patients adultes ayant un indice de masse corporelle ≤ 40 kg· m−2 venant pour chirurgie ambulatoire et nécessitant une SGA ont été randomisés pour bénéficier de l’Auragain ou du Supreme. L’anesthésie a été induite avec de la lidocaïne (1 mg· kg−1), du fentanyl (1-2 μg·kg−1) et du propofol (2-3 mg· kg−1). La SGA a été insérée selon une technique standard et le ballonnet a été gonflé à 60 cmH2O. Le principal critère d’évaluation comparé entre les deux groupes était l’OLP.


Cent soixante-cinq patients (n = 81, Auragain; n = 84, Supreme) ont terminé l’étude. Les données démographiques étaient similaires entre les groupes. L’OLP moyenne (écart-type [ÉT]) était significativement plus élevée dans le groupe Auragain que dans le groupe Supreme (respectivement, 26,4 [2,8] cmH2O contre 21,6 [3,4] cmH2O; différence des moyennes, 4,8 cmH2O; intervalle de confiance [IC] à 95 % : 3,9 à 5,8; P < 0,001). Le temps moyen (ÉT) d’insertion a été plus long dans le groupe Auragain que dans le groupe Supreme (respectivement, 13 [4] s contre 11 [3] s; différence des moyennes, 2 s; IC à 95 %, 1 à 3 s; P < 0,001).


Chez les patients subissant une anesthésie ambulatoire, l’OLP a été plus élevée avec l’Auragain qu’avec le Supreme, mais son insertion a pris plus de temps. Une OLP plus élevée pourrait permettre d’utiliser les SGA dans un plus vaste éventail de procédures et de patients.

Enregistrement de l’essai clinique (NCT02816463). Enregistré le 28 juin 2016.



The authors thank the anesthesiologists who participated in this study. The authors also thank Ambu Inc. (Ambu AuraGain™) and Teleflex Medical Canada Inc. (LMA Supreme™) for providing the SGAs free of charge for this study.

Conflicts of interest

None declared.

Editorial responsibility

This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal of Anesthesia.

Author contributions

David T. Wong and Kawal P. Singh contributed substantially to all aspects of this manuscript, including conception and design, acquisition, analysis, interpretation of data, and drafting the article. Alister Ooi and Frances Chung contributed substantially to the conception, design, and drafting of the manuscript. Jason Lau, Mandeep Singh, and Jean Wong contributed to analyses of data and drafting of the article. Amelie Dallaire and Vina Meliana contributed to the acquisition and analysis of data and drafting of the article.


This study was supported in part by the Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, and by the Toronto General & Western Hospital Foundation.

Ambu Inc. (Ambu AuraGain™) and Teleflex Medical Canada Inc. (LMA Supreme™) provided the supraglottic airways free of charge for this study.


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Copyright information

© Canadian Anesthesiologists' Society 2018

Authors and Affiliations

  1. 1.Department of Anesthesia, Toronto Western Hospital, University Health NetworkUniversity of TorontoTorontoCanada
  2. 2.Northern AnaestheticsFlemingtonAustralia

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