Comparison of Gastric Insufflation Volume Between LarySeal Pro and Ambu AuraGain Using Ultrasonography In Pediatric Patients Undergoing General Anesthesia With Controlled Ventilation.

Plain-language summary

Gastric air insufflation during insertion of a laryngeal mask airway (LMA) is a known phenomenon and can have important clinical implications, especially in relation to: During positive pressure ventilation or improper insertion technique, air can be forced into the esophagus and stomach or LMAs do not fully seal the esophagus, so high ventilation pressures or incorrect placement may lead to gastric insufflation. Which may lead to Increased risk of regurgitation and aspiration, especially if the gastric contents reach the upper esophagus, Abdominal distension, which can reduce ventilation efficiency, nausea, vomiting, or delayed gastric emptying postoperatively which detected by Epigastric auscultation may reveal gurgling sounds during ventilation, Gastric ultrasound can visualize the extent of gastric insufflation and Capnography sometimes shows altered patterns if regurgitation begins . This complication prevented by: * Use low-pressure, controlled ventilation (\<20 cmH₂O). * Ensure proper size and positioning of the LMA. * Use second-generation LMAs (like LarySealPro or Ambu AuraGain LMA) that have gastric drainage ports to relieve air. Consider gastric ultrasound preoperatively to assess risk . (1) Several studies have assessed the performance of Ambu AuraGain and LarySeal Pro individually or in comparison with other supraglottic airway devices. Ambu AuraGain, a second-generation device with a gastric drainage channel, has demonstrated high oropharyngeal leak pressures and ease of insertion, making it suitable for positive pressure ventilation. LarySeal Pro has also shown favorable results in terms of low airway resistance and effective sealing in adults. However, direct comparisons between these two devices are limited, especially regarding gastric insufflation volume measured by ultrasonography, which offers objective and quantitative assessment. Although some adult studies have evaluated AuraGain against devices like ProSeal or i-gel, there is a notable lack of pediatric studies directly comparing AuraGain and LarySeal Pro using gastric ultrasound techniques.(2) To date, no published randomized controlled trials have directly compared gastric insufflation volumes between Ambu AuraGain and LarySeal Pro using ultrasonography in pediatric patients under general anesthesia. This represents a critical gap in the literature, given the increased risk of aspiration in children and the growing use of ultrasound to evaluate perioperative gastric content. Compared to Endotracheal intubation , SADs offer reported advantages such as simplicity in insertion, elimination of neuromuscular blocking agents, enhancement of spontaneous respiration, and avoidance of translaryngeal positioning accompanied by cardiovascular effects and close vocal cord contact. reduced rate of laryngospasm and a lower incidence of postoperative hoarse voice, coughing and sore throat. (3) Despite this, the use of these device may be associated with various complications as regurgitation and aspiration of gastric contents, compression of vascular structures, trauma, and nerve injury.(4). The LMA can be a useful airway device in pediatric patients as well as adults, despite clear differences between the anatomy of the pediatric and adult airway. Sizes I, 2, and 2 1/2 are available for use in infants and children. In general, children require greater anesthetic depth prior to placement . The LMA can be placed successfully in children after either an inhalational or intravenous induction of anesthesia. (5) Ambu AuraGain and LarySeal Pro are designed with a cuff modified to improve the seal around the glottis and a drainage tube to provide a bypass channel for regurgitated gastric contents, prevent gastric insufflation, and allow the passage of a gastric tube. These features are designed to improve the safety of the mask and broaden its scope, especially when used with positive pressure ventilation.(6) Aim of the work The aim of the study is to compare the gastric insufflation volume between the LarySeal Pro Laryngeal Mask and Ambu AuraGain Laryngeal Mask in pediatric patients undergoing general anesthesia with controlled ventilation. Objectives: To assess and compare gastric insufflation volume between LarySeal Pro laryngeal mask and Ambu AuraGain laryngeal mask in pediatric patients using pelviabdominal ultrasound undergoing general anesthesia. Hypothesis We hypothesize that LarySeal Pro laryngeal mask produce gastric insufflation volume less than Ambu AuraGain laryngeal mask in pediatric patients undergoing general anesthesia.

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