A Comparison of Tracheal Intubation with Ambu® AuraGain™, Fastrach® and BlockBuster® Laryngeal Mask Airway: A Randomised Clinical Trial

Introduction: Airway management has been a key to quality, efficacy and safety of anaesthesia. The Ambu((R)) AuraGain (TM) is an anatomically curved Supraglottic Airway Device (SAD), which has gastric access port and is used for both ventilation and endotracheal intubation. Fastrach((R)) Intubating Laryngeal Mask Airway (FT-LMA) serves as a conduit for intubation and ventilation for difficult airway situation. It has an epiglottic elevating bar designed to lift the epiglottis as endotracheal tube passes. BlockBuster((R)) LMA is latest generation LMA used for ventilation and intubation. It has a short airway tube which has > 95 degrees angulation to match the oropharyngeal curve and thus makes the insertion easy and less traumatic. Aim: To compare first attempt success rate of tracheal intubation using Ambu((R)) AuraGainT, Fastrach((R)) and BlockBuster((R)) LMA in adult patients. Materials and Methods: The present randomised clinical trial was conducted in the Department of Anaesthesiology, Ravindra Nath Tagore Medical College, Udaipur, Rajasthan, India from February 2021 to February 2022. The study comprised of 135 ASA physical status I and II patients of both sex, aged 18-60 years who were admitted and scheduled for elective surgery requiring general anaesthesia and tracheal intubation. The patients were randomly assigned into three groups (45 in each) - group A (Ambu((R)) AuraGain (TM) group), group F (Fastrach((R)) group), and group B (BlockBuster((R)) group). Tracheal intubation was performed using appropriate size endotracheal tube after LMA placement. The outcome measures were first attempt successful intubation, time taken for intubation, glottis visualisation, and incidence of complications (blood stained LMA, nausea/vomiting). Results: The mean age of the group A, group B and group F were 35.8 +/- 15.0, 32.71 +/- 12.59, and 38.7.0 +/- 14 respectively which was statistically not significant. Group B had a significantly greater success rate of first attempt intubation (93.3%) in comparison with group F (64.4%), and group A (22.2%). LMA insertion score of 1 was found in 53.3% patients in group B, 42.2% patients in group F and 15.5% patients in group A. A Brimacombe score of 4 was found in 46.6% patients in group B as compared to 13.3% patients in group F and (33.3%) patients in group A, (p-value=0.020). Blood stained LMA was found in 1 patient in group B, 9 in group F and 7 in group A (p-value=0.030). Conclusion: BlockBuster((R)) LMA is a better conduit for tracheal intubation than Fastrach((R)) LMA and Ambu((R)) AuraGainT in adult patients with no anticipated airway difficulties.