Optimizing Airway Management in Obese Patients: A Comparative Study of Supraglottic Airway Devices

Obesity presents distinctive obstacles in airway management for anesthesiologists. Anatomical characteristics like heightened neck circumference and localized fat buildup around the neck can create complexities in airway management. Supraglottic airway devices (SADs) offer various clinical benefits, including straightforward insertion, high success rates, potential assistance in endotracheal intubation, minimal intubation failure rates, and reduced airway-related complications. Limited research has explored the utilization of supraglottic airway devices (SADs) specifically in obese patients. Recent study conducted a randomized comparative investigation to evaluate the oropharyngeal leak pressure (OLP) of four different supraglottic airway devices (SADs) in obese patients undergoing elective surgery. The devices compared were I-gel, Ambu AuraGain, Baska mask, and Laryngeal Mask Airway (LMA) Protector. The primary outcome measured was the OLP, with secondary outcomes including success rate, leak fraction (LF), insertion time, fiber-optic view, hemodynamics, and complications.

The study included 154 obese patients aged 18-60 undergoing elective surgery, with 38 patients in each group allocated to one of the four SADs. Results indicated that the Baska mask had the highest OLP, while the LMA Protector had the lowest OLP. The Baska mask also exhibited the highest LF, while Ambu AuraGain had the lowest. The time taken for insertion was shortest with I-gel and longest with Ambu AuraGain. Heart rate, success rate, fiber-optic view, blood pressure, and complications were similar across the devices. All devices had a 100% success rate of insertion. Obesity presents challenges in airway management due to anatomical factors, making SADs valuable tools. Previous studies have not extensively included obese patients, and this trial aimed to bridge this gap by comparing the performance of I-gel and newer SADs in obese patients. The Baska mask, Ambu AuraGain, and LMA Protector were found to be acceptable choices alongside I-gel for obese patients undergoing elective surgery.

Study Limitations

The study's limitations included being single-blind and the influence of laparoscopic surgery on some variables recorded post-surgery. Despite small significant differences in OLP, LF, and insertion time, all four devices were deemed suitable for obese patients undergoing elective surgery. The minimal differences were not clinically relevant, suggesting the devices' comparability in obese patients.

Conclusions

In conclusion, while the Baska mask demonstrated the highest OLP, all devices - I-gel, Ambu AuraGain, and LMA Protector - were considered viable options for airway management in obese patients. The study suggested that I-gel and Baska mask may be favorable for obese patients requiring rapid airway control due to their shorter insertion times. The study emphasized the importance of selecting appropriate SADs for effective airway management in obese patients undergoing surgery, with considerations for OLP, LF, and insertion time.

Key Points

- The study compared the oropharyngeal leak pressure (OLP) of four supraglottic airway devices (SADs) - I-gel, Ambu AuraGain, Baska mask, and Laryngeal Mask Airway (LMA) Protector in obese patients undergoing elective surgery.

- Results showed that the Baska mask had the highest OLP, whereas the LMA Protector had the lowest OLP. The Baska mask also had the highest leak fraction (LF), while Ambu AuraGain had the lowest. Insertion time was shortest for I-gel and longest for Ambu AuraGain.

- All four devices had a 100% success rate of insertion with similar outcomes in heart rate, success rate, fiber-optic view, blood pressure, and complications.

- The study addressed the challenges in airway management posed by obesity and aimed to fill the gap in research focusing on obese patients by comparing the performance of I-gel and newer SADs.

- Despite some limitations such as single blinding and the impact of laparoscopic surgery on post-surgery variables, all four devices were deemed suitable for obese patients undergoing elective surgery.

- While the Baska mask showed the highest OLP, all devices (I-gel, Ambu AuraGain, and LMA Protector) were deemed suitable for airway management in obese patients, with I-gel and Baska mask potentially preferred for rapid airway control due to their quicker insertion times.

Reference –

Rajesh Raman et al. (2025). Comparison Of I-Gel®, Ambu® AuraGain™, Baska Mask, LMA® Protector™ For Airway Management Of Obese Surgical Patients - A Randomised Comparative Study. *Indian Journal Of Anaesthesia*. https://doi.org/10.4103/ija.ija_755_24