• Darhae Eum, Ha Yan Kim, Yangjin Kim, and Seokyung Shin.
• Department of Anesthesiology and Pain Medicine, Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodamungu, Seoul 03722, Republic of Korea. Electronic address: deum@yuhs.ac.
• J Clin Anesth. 2024 Oct 11; 99: 111652111652.

Study ObjectiveReports are limited regarding supraglottic airway (SGA) usage in children in the prone position. This study aimed to compare the clinical performance of the Ambu®AuraGain™, a 2nd generation SGA, in children undergoing surgery in the prone and supine positions. We hypothesized that oropharyngeal leak pressure (OLP) in the prone position would not be inferior to that in the supine position.DesignSingle-center, prospective, non-randomized controlled study.SettingOperating room.PatientsOne hundred and twenty-six children, American Society of Anesthesiologists (ASA) physical status I-III, aged 2-12 years, undergoing elective surgery for 2 h or less in the supine or prone position.InterventionsAfter induction of general anesthesia and insertion of the AuraGain, patients were positioned either supine or prone, according to type of surgery.MeasurementsOLP immediately after surgical positioning was measured as the primary outcome. The anatomical position of the AuraGain was evaluated using a flexible fiberoptic bronchoscope (Olympus LF-DP Tracheal Intubation Fiberscope, Melville, New York, USA). Airway maneuvers performed during placement and maintenance of the AuraGain and airway-related adverse events were recorded.Main FindingsThe mean difference in OLP immediately after positioning was 0.048 cmH2O (95 % confidence interval: -1.521 to 1.616), and the non-inferiority hypothesis was accepted (P < 0.001 for non-inferiority). There was no significant difference in the anatomical position of the SGA and adverse events. Airway maneuvers were significantly more commonly performed during placement in the Prone group compared to the Supine group (51 (81.0 %) vs. 3 (4.8 %), respectively; P < 0.001).ConclusionOLP when using AuraGain in the prone position in children was not inferior to that in the supine position. This suggests that the AuraGain may be an effective option for children undergoing short surgical procedures in the prone position.Copyright © 2024 Elsevier Inc. All rights reserved.

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