Gastric insufflation volume using I-gel versus Ambu Aura Gain in pediatric patients undergoing elective orthopedic operations under general anesthesia: a prospective randomized trial

Background The Ambu AuraGain and i-gel are second-generation supraglottic airway devices (SADs) with distinct structural designs. Despite their widespread use, there is limited comparative research evaluating their effectiveness in paediatrics under general anesthesia, especially concerning the risk of gastric insufflation. Aim Is to compare between i-gel and Ambu AuraGain according to gastric insufflation and their performance in paediatric patients during orthopedic surgery. Patients and methods Sixty children between 2 and 12 years undergoing orthopedic procedures were randomly assigned to be managed with i-gel or AuraGain as the airway device. The primary outcome assessed was the cross sectional area (CSA) of the antrum of the stomach. Secondary outcomes included oropharyngeal leak pressure, peak airway pressure (PAP), time of insertion for the SAD, number of insertion trials, ease of inserting the SAD and Ryle’s tube, intraoperative hemodynamic parameters, and postoperative complications. Results CSA and gastric residual volume were similar between the groups at all estimated time points. The i-gel demonstrated a significantly higher oropharyngeal leak pressure (23–28 cmH₂O) compared with the AuraGain (17–26 cmH₂O), while PAP was similar ( P =0.302). i-gel had less insertion time (12–17 s) than AuraGain (15–22 s). No differences were observed in insertion trials or ease of insertion of devices ( P =0.285). However, Ryle’s tube insertion was significantly easier with AuraGain. Hemodynamic changes and postoperative complications were comparable. Conclusion Both devices were effective without causing significant gastric insufflation. i-gel had superior sealing and faster insertion, while AuraGain allowed easier Ryle’s tube placement.