Refining the Pathway to the Trachea: Fiberoptic Intubation Using AMBU Aura Gain Versus LMA Fastrach

Abstract

Introduction: Effective airway management is a cornerstone of anesthesiology and critical care, especially in patients with difficult airways. While direct laryngoscopy is the traditional method for tracheal intubation, it can be challenging in anatomically complex cases. Fiberoptic-guided intubation offers a safer, more controlled alternative, particularly when used in conjunction with supraglottic airway devices (SADs). The Ambu Aura Gain and LMA Fastrach are commonly employed SADs that serve as conduits for fiberoptic intubation. The Fastrach features a rigid design with an epiglottic elevating bar, while the Aura Gain offers a softer, anatomically curved profile with integrated gastric access. Despite widespread use, direct comparisons of their performance as fiberoptic conduits are limited. This study compares these two devices in terms of ease of insertion, success rate, and clinical utility in difficult airway management.

Methodology: This prospective, randomized study included 80 ASA I–II patients aged 18–60 years, allocated into two groups (n=40 each) for fiberoptic-guided tracheal intubation using either LMA Fastrach or Ambu AuraGain. Following standard preoperative preparation and induction, the assigned supraglottic device was inserted. Demographic data (age, gender, BMI) were recorded. Glottic view was assessed using the Brimacombe and Berry scoring system. Ease of intubation was evaluated by number of attempts and perceived difficulty. Complications such as mucosal trauma, desaturation (SpO₂ < 95%), and failed intubation were documented. Data was collected by a blinded observer and analyzed using SPSS.

Results: The demographic profiles of both groups were comparable, with no significant differences in age (p = 0.38), sex distribution (p = 0.500), or BMI (mean = 24.6 kg/m²). This indicates effective randomization. Success rates of ETT insertion were similar across groups. However, fiberoptic glottic view was significantly better with Ambu AuraGain, showing more Grade 4 views (80%) compared to LMA Fastrach (50%) (p = 0.021). Intubation time was significantly shorter with Ambu AuraGain, both pre-SAD removal (p < 0.001) and overall (p = 0.003).

Conclusion: Both Ambu AuraGain and LMA Fastrach proved effective as conduits for fiberoptic-guided tracheal intubation. Ambu AuraGain demonstrated significantly better glottic visualization and faster intubation times. Success rates and ease of insertion were comparable between the groups. No major complications were noted in either device. Ambu AuraGain may offer advantages in scenarios requiring efficient and clear airway access.