<![CDATA[Second-generation supraglottic airway devices incorporate a gastric drainage channel, but comparative evidence versus conventional single-use laryngeal mask airways remains limited. To compare first-attempt insertion success, insertion time, oropharyngeal leak pressure (OLP), and perioperative complications between the Single-Use Laryngeal Mask Airway with Gastric Drain (SULMAGD) and conventional Single-Use Laryngeal Mask Airway (SULMA). In a single-center randomized controlled trial, 304 ASA I–II adults undergoing elective surgery were randomized 1:1 to SULMAGD or SULMA. The primary outcome was first-attempt insertion success, tested under a non-inferiority margin of 7 percentage points. First-attempt insertion success was comparable (93.4% vs. 92.1%; absolute risk difference 1.3%, 95% CI-4.6 to 7.2), meeting the pre-specified non-inferiority criterion. Insertion times were statistically different but clinically similar (median 5.0 s in both groups). OLP was significantly higher with SULMAGD (26 vs. 19 cmH2O; median difference 7 cmH2O, p <0.001). No major complications, including aspiration, desaturation, laryngospasm, or airway trauma, occurred in either group. In low-to-moderate-risk adults, SULMAGD achieved non-inferior first-attempt insertion success and provided higher OLP than SULMA, potentially benefiting cases requiring higher positive-pressure ventilation. Findings are limited to elective ASA I–II patients and require multicenter validation.]]>
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