A Modified Insertion Technique of Ambu AuraGain™ Laryngeal Airway, a Third-generation Supraglottic Airway to Reduce the Oral Mucosal Injury

Sir, Ambu AuraGainTM[1] is a new single-use supraglottic airway (SGA) device available in adult size 3, 4, and 5. It is an anatomically curved SGA with integrated gastric access and can be used as a conduit for direct endotracheal intubation assisted by a flexible scope.[1] The standard recommended insertion technique is as that of intubating laryngeal mask airway (LMA),[2] i.e., keeping the handle (Shaft) approximately parallel to the patient’s chest and then pushing the device along the hard palate after opening the mouth [Figure 1a]. With the previous experience of other faculty and residents with this device in our institute, we noticed that a higher tangential force is required for the placement due to bulky and acute angle of the device. Due to difficulty in insertion, few cases also resulted in oral mucosal injury in the form of bleeding and ulceration with inadequate sealing and higher airway pressure.