Ambu AuraOnce User manual

Product Information
Ambu®AuraOnce™
Single Use Laryngal Mask - Sterile
For use by trained clinicians only

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Product information
This product information may be updated without further notice. Copies of the current version are available from
the manufacturer.
Contents Page
1. Warnings/Cautions 3
2. Introduction 4
2.1. Intended use 4
2.2. Contraindications 4
3. Specifications 4
3.1. Materials 5
4. Principles of operation 6
5. Adverse effects 6
6. Preparation for use 6
6.1. Functional testing 6
6.1.1. Test 1 - Visual inspection 7
6.1.2. Test 2 - Inflation/deflation test 7
7. Insertion 8
7.1. Pre-insertion preparation 8
7.2. Insertion 8
7.3. Insertion techniques 8
7.3.1. Placement technique 9
7.4. Insertion problems 9
7.5. Inflation 9
7.6. Connecting to the anesthetic system 10
7.7. Fixation 10
7.8. Usage with spontaneous ventilation 11
7.9. Usage with positive pressure ventilation 11
7.10. Critical observations during use 11
7.11. Recovery 12
7.12. Removal procedure 12
8. Specialized use 12
8.1. Intubation through the Ambu AuraOnce 12
8.2. Use of the Ambu AuraOnce for blind tracheal intubation 13
8.3. Pediatric Use 13
8.4. Critical situations and emergencies 13
8.4.1. Critical situations 13
8.4.2. Emergencies 13
8.5. Magnetic resonance imaging (MRI) 13
Illustration 14-15
Symbols 16
Addresses 17
US: Rx only
Ambu®is registered trademark of Ambu A/S, Denmark.
Ambu A/S is certified according to ISO 9001, and ISO 13485.

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1. Warnings/Cautions
Throughout these directions for use, appropriate warnings are given describing potential safety hazards associated
with use of the Ambu AuraOnce.
WARNING
The user should be familiar with the following warnings prior to use of the Ambu AuraOnce.
• The Ambu AuraOnce is delivered sterile.
• Lubricate only the posterior tip of the cuff to avoid blockage of the airway aperture or aspiration of the
lubricant.
• To avoid trauma, do not use force at any time during insertion of the Ambu AuraOnce.
• Adhere strictly to the recommended cuff inflation volumes as specified in Table 3. Never over-inflate the cuff
after insertion.
• Ambu AuraOnce is to be used in patients, who have been clinically evaluated by a clinician familiar with
anaesthesia as eligible for a Supraglottic Airway Device.
• In patients with severe oropharyngeal trauma, the Ambu AuraOnce should only be employed when all other
attempts to establish an airway have failed.
• The Ambu AuraOnce is flammable in the presence of lasers and electrocautery equipment.
• Use of a nasogastric tube may make regurgitation likely because the tube may interfere with the function of
the lower esophageal sphincter.
• Do not attempt to clean and reuse the Ambu AuraOnce.
CAUTION
• US federal law restricts this device to be sold to or on the order of a physician.
• For use only by clinicians trained in the use of a Ambu AuraOnce.
• Ensure that the device is not in any way damaged before use
• Make a brief functional check as described in section 6 before using the device. Failure of any test indicates
that the device should not be used.
• If airway problems persist or ventilation is inadequate, the Ambu AuraOnce should be removed and
reinserted or a secure airway established by other means.
• Patients should be adequately monitored at all times during use.
• The secure function of all anaesthetic breathing system connectors should be checked before the breathing
circuit is established.
• To minimize contamination, always wear gloves during the preparation and insertion of the Ambu AuraOnce.
• Have a spare Ambu AuraOnce ready and prepared for immediate use.
• When used with MRI, care should be taken to monitor the patient carefully to ensure that correct positioning
of the tube is maintained.

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2. Introduction
2.1. Intended use
The Ambu AuraOnce is intended for use as an alternative to a facemask for achieving and maintaining
control of the airway during routine and emergency anaesthetic procedures in fasted patients.
The Ambu AuraOnce may also be used where unexpected difficulties arise in connection with
airway management.
The mask may also be preferred in some critical airway situations.
The Ambu AuraOnce may also be used to establish a clear airway during resuscitation in
profoundly unconscious patients with absent glossopharyngeal and laryngeal reflexes who may
need artificial ventilation.
The device is not intended for use as a replacement of the endotracheal tube, and is best suited for
use in surgical procedures where tracheal intubation is not deemed necessary.
2.2. Contraindications
The Ambu AuraOnce does not protect the patient from the consequences of regurgitation and
aspiration. Ambu AuraOnce should only be used in patients, who have been clinically evaluated by
a clinician familiar with anesthesia, as eligible for a laryngeal mask airway.
When the Ambu AuraOnce is used in profoundly unconscious patients in need of resuscitation or in
an emergency patient with a difficult airway situation (i.e. “cannot intubate, cannot ventilate”), there
is a risk of regurgitation and aspiration. This risk must be carefully balanced against the potential
benefit of establishing an airway (see the guidelines etablished by your own local protocol). The
Ambu AuraOnce should not be used for resuscitation or emergency treatment of patients who are
not profoundly unconscious and who may resist insertion.
3. Specifications
The Ambu AuraOnce function is in conformity with Council Directive 93/42/EEC concerning
Medical Devices and ASTM standard no. ASTM F 2560-06 Standard Specification for
Supralaryngeal Airways and Connectors. A summary of the methods, materials, data and
results of clinical studies that validate the requirements of this standard is available on request,
if applicable.
The Ambu AuraOnce is a sterile and single use device.
0086

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3.1. Materials
The Ambu AuraOnce is 100% latex free. The materials used for the product and packaging are:
Mask size
#1 #1½ #2 #2½ #3 #4 #5 #6
cAirway connector 15 mm male (ISO 5356-1)
dMin. I.D. Tube 5,2 mm 7,3 mm 8,6 mm 8,5 mm 8,5 mm 9,6 mm 10,6 mm 11,3 mm
dMax. O.D. Tube 10,5 mm 13 mm 15 mm 17,5 mm 17,5 mm 20 mm 22,5 mm 25 mm
f Inflation Valve Luer cone (ISO 594-1)
Appropriate storage
temperature
10 °C (50 °F) to 25 °C (77 °F)
Dimensions (mm)
(length x width x height)
97x
24x70
112x
29x82
128x
34,5x95
148x
41x109
148x
49x116
168x
56x132
187x
64x148
200x
69x165
Weight 9,2 g 13,4 g 19,3 g 27,8 g 30,8 g 43,7 g 59,9 g 75,1 g
Internal volume of
ventilatory pathway 5,5 ml 8 ml 11 ml 15 ml 16 ml 21 ml 30 ml 38 ml
Pressure drop
Min. interdental gap 15 mm 17 mm 19 mm 21 mm 25 mm 29 mm 31 mm 32 mm
i Internal pathway 10,3 cm 12,0 cm 13,8 cm 15,9 cm 15,9 cm 17,8 cm 20,0 cm 22,0 cm
Table 1. Specifications for the Ambu AuraOnce
Part Material
c Airway connector Polypropylene (PP)
d/e Tube/Cuff PVC Medical compound
f Pilotballoon with inflationvalve PVC/PC/Silicone
h Pilot tube PVC Medical compound
Packaging - Vacuum shaped tray GPET
Packaging - Pouch Tyvek
Table 2. Material used for the Ambu AuraOnce
See figure cAmbu AuraOnce
<1,2 cmH2O
at 15 l/min
<0,8 cmH2O
at 15 l/min
<1,0 cmH2O
at 30 l/min
<0,8 cmH2O
at 30 l/min
<2,0 cmH2O
at 60 l/min
<1,2 cmH2O
at 60 l/min
<0,8 cmH2O
at 60 l/min
<0,5 cmH2O
at 60 l/min
See figure c. Ambu AuraOnce.

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5. Adverse effects
Use of the Ambu AuraOnce may cause minor adverse effects (e.g., sore throat) and major adverse effects
(e.g., aspiration).
6. Preparation for use
6.1. Functional testing
Functional testing as described below must be carried out before using the device. The tests should be conducted
in a manner consistent with accepted medical practice that minimizes contamination of the Ambu AuraOnce prior
to insertion.
CAUTION
• Handle the Ambu AuraOnce carefully as it is made of PVC which can be torn or punctured. Avoid contact
with sharp or pointed objects.
• Always wear gloves during the preparation and insertion of the Ambu AuraOnce to minimize contamination.
• Make sure that the cuff protector has been removed from the cuff
4. Principles of operation
The Ambu AuraOnce comes in eight different sizes for use in patients of different weight. See table below for
selection guidelines and max. inflation volumes. Please note that the cuff inflation volumes shown in table 3 are
maximum volumes. Applying the stated maximum inflation volume may respond to a cuff pressure above the
maximum of 60 cm H2O. It is recommended to continuously monitor the cuff pressure.
Mask size
#1 #1½ #2 #2½ #3 #4 #5 #6
Patient weight <5 kg 5-10 kg 10-20 kg 20-30 kg 30-50 kg 50-70 kg 70-100 kg >100 kg
Maximum cuff
inflation volume 4 ml 7 ml 10 ml 14 ml 20 ml 30 ml 40 ml 50 ml
Maximum intracuff
pressure 60 cm H2O
Table 3. Selection guidelines for the Ambu AuraOnce
The mask is designed to conform with the contours of the hypopharynx with its lumen facing the laryngeal opening.
When correctly inserted, the distal tip of the cuff rests against the upper oesophageal sphincter.
See figure d. Correct position of the Ambu AuraOnce in relation to anatomical landmarks
Anatomical Landmarks
A - Esophagus G - Hyoid bone
B - Trachea H - Tongue
C - Cricoid ring I - Buccal cavity
D - Thyroid cartilage J - Nasopharynx
E - Laryngeal inlet K - Incisors
F - Epiglottis
Table 4. Description of anatomical landmarks and Ambu AuraOnce parts
AuraOnce parts
1 - Patient end
2 - Size marking
3 - Ventilatory opening
4 - Ventilatory pathway
5 - Normal depth of insertion marks
6 - Machine end

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6.1.1. Test 1 - Visual inspection
Closely examine the Ambu AuraOnce for any damage, such as perforation, scratches, blockage, loose parts, etc.
Do not use the Ambu AuraOnce if it is damaged in any way.
6.1.2. Test 2 - Inflation/deflation test
Ambu recommends to deflate the cuff of the Ambu AuraOnce completely. Once deflated, check the cuff thoroughly
for any wrinkles or folds. Over-inflate the cuff to the appropriate volume as specified in Table 5. Check that the
inflated cuff is symmetrical and smooth. There should not be any bulge nor any sign of leakage in the cuff, pilot
tubing or pilot balloon.
WARNING
Do not use the Ambu AuraOnce if there are any bulges on the cuff or if there are any signs of leakage.
Table 5. Test cuff over-inflation volumes for the Ambu AuraOnce
CAUTION
The inflation volumes specified in Table 5 are for testing purposes only. These volumes are not to be used
during normal use of the device – the recommended standard inflation volumes can be found in Table 3.
Mask size
#1 #1½ #2 #2½ #3 #4 #5 #6
Over-inflation
cuff volumes 6 ml 10 ml 15 ml 21 ml 30 ml 45 ml 60 ml 75 ml
WARNING
• Do not use the device if any test fails.
• Dispose of the Ambu AuraOnce in a safe manner according to local guidelines of medical waste.

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7. Insertion
7.1. Pre-insertion preparation
Before insertion Ambu recommends to deflate the cuff completely so that the cuff is flat and free of wrinkles.
Simply press the cuff down onto a flat sterile surface (e.g. a piece of sterile gauze) while at the same time deflating
the device with a syringe. Complete deflation results in a shape similar to the rim of a saucer, and facilitates insertion
and correct positioning of the device.
Studies show that insertion of the laryngeal mask airway with the cuff either deflated or partly inflated is equally
successful in experienced hands. Therefore the clinician can insert the Ambu AuraOnce with a deflated or partly
inflated cuff, since both ways works succesfully.
See figure e. Deflation of Ambu AuraOnce.
WARNING
Lubricate only the posterior tip of the cuff to prevent blockage of the airway aperture or aspiration of
the lubricant.
To further facilitate insertion into the patient, a sterile, water-based lubricant (e.g. K-Y Jelly®) should be applied
to the distal posterior surface of the cuff (local anaesthesia is not recommended).
7.2. Insertion
Before insertion, it is essential that all clinicians using the Ambu AuraOnce are familiar with the warnings, precautions,
indications, and contraindications found in these Product Information.
The following points are extremely important:
• Check for correct deflation and lubrication as described above.
• The size of the Ambu AuraOnce must fit the patient. Use the guidelines in Table 3 combined with clinical judgement
to select the correct size.
• Always have a spare Ambu AuraOnce ready for use.
• Pre-oxygenate and use standard monitoring procedures.
• Check that the level of anaesthesia (or unconsciousness) is adequate before attempting insertion.
• The head of the patient should be position extended with flexion of the neck in a position normally used for
tracheal intubation (i.e. “the sniffing position”).
• Never use excessive force.
7.3. Insertion Techniques
There are many insertion techniques currently in use. Insert the Ambu AuraOnce in accordance with currently accepted
medical techniques. One commonly used technique is the Pencil Insertion Technique, which is described below.
When inserting the Ambu AuraOnce correctly, you must be careful about the following: Ensure that the cuff tip
avoids entering the valleculae or the glottic opening and does not become caught up against the epiglottis or the
arytenoids. The cuff should be deflated and pressed against the patient’s posterior pharyngeal wall.
When the mask is in place, resistance will be felt.

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7.3.1. Placement Technique
Provided that access to the patient’s head from above is feasible, the Pencil Insertion Technique provides better
positioning than other insertion techniques. The airway tube is held like a flute, with three fingers placed above the
junction of the cuff and the tube (Figure 4) and the thumb on the vertical line on the airway tube, which is oriented
anteriorly toward the patient’s nose. Your other hand should be placed under the patient’s head.
See figure f. Positioning the Ambu AuraOnce using the Pencil Insertion Technique
Insert the tip of the cuff pressing upwards against the hard palate and flatten the cuff against it. Look carefully into the
mouth to verify that the tip of the cuff is correctly flattened against the palate before proceeding – push the jaw gently
downwards with your middle finger to open the mouth further.
See figure g. Positioning the Ambu AuraOnce using the Pencil Insertion Technique
As the tip of the cuff is placed correctly in the mouth opening, continue the movement by swinging the mask
inward with a circular motion, pressing the contours of the hard and soft palate. Then advance the Ambu AuraOnce
into the hypopharynx until a definite resistance is felt (Figure 5). The motion of the placement should be smooth.
Do not use force. The Ambu AuraOnce should now be correctly located with its tip resting against the upper
esophageal sphincter.
7.4. Insertion Problems
Coughing and breathholding during Ambu AuraOnce insertion indicates inadequate depth of anaesthesia –
immediately deepen anaesthesia with inhalational or intravenous agents, and initiate manual ventilation.
If you cannot open the patient’s mouth sufficiently to insert the mask, check that the patient is adequately
anesthetized. Ask an assistant to pull the jaw downwards thus making it easier to see into the mouth and verify
the position of the mask.
Difficulty in manoeuvring the angle at the back of the tongue is one of the most common problems encountered
when inserting the Ambu AuraOnce. The tip must be pressed against the palate throughout or else the tip may fold
on itself or meet an irregularity in the posterior pharynx, e.g. hypertrophied tonsils. Should the cuff fail to flatten
or begin to curl over as it is inserted, withdraw the mask and reinsert it. In case of tonsillar obstruction, a diagonal
movement of the mask is recommended.
WARNING
Force should never be used during insertion.
7.5. Inflation
After insertion, the vertical line on the airway tube should be oriented anteriorly towards the patient’s nose. The
typical range of intended depth insertion is marked by the two horizontal lines on the airway tube (see figure d,
item 5). The Ambu AuraOnce is inserted correctly when the patient’s incisors are between these markings.
Reposition the mask if the patient’s incisors are outside this range. Without holding the tube, inflate the cuff with
just enough air to obtain a seal, equivalent to intracuff pressures of approximately 60 cm H2O. In many cases, only
half of the maximum volume is sufficient to achieve a seal – please refer to Table 3 for maximum volumes. Check
the cuff pressure continuously during the surgical procedure, either with a cuff pressure gauge or by feeling the
tension in the pilot balloon. This is especially important when N2O gases are used.
See figure h. Inflation of Ambu AuraOnce.

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Never over-inflate the cuff. Avoid prolonged intracuff pressures greater than 60 cm H2O. The initial cuff
pressure varies according to patient, mask size, head position, and depth of anaesthesia.
Do not hold the tube during inflation as this prevents the mask from seating itself correctly. A small outward
movement of the tube may be seen as the mask is inflated.
To avoid over inflation, it is very important to strictly adhere to the cuff-inflation volumes stated in Table 3.
Over-inflation can be entirely avoided by completely deflating the cuff prior to insertion by withdrawing all of the
air with a suitable syringe. This is the method recommended by Ambu.
In instances where an alternative technique is adopted, for example, if the cuff is inserted in a neutral or
semi-inflated state, there is a risk that the cuff may be over-inflated. Once the mask is inserted extra care must
be taken to compensate for the air already in the mask when subsequently inflating the cuff. The maximum extra
volume depends on mask size and initial volume of air in the mask when inserted.
WARNING
Never overinflate the cuff after insertion.
Look for the following signs of correct placement: The possible slight outward movement of the tube upon cuff
inflation, the presence of a smooth oval swelling in the neck around the thyroid and cricoid area, or no cuff visible
in the oral cavity.
7.6. Connecting to the Anaesthetic System
Carefully connect the Ambu AuraOnce to the anaesthetic circuit or ventilation bag and initiate gentle manual
ventilation, looking for any signs of leakage. Auscultation over the lungs and epigastrium and capnography should
be used to determine sufficient respiration. Auscultate in the anterolateral neck region to check for abnormal
sounds that might indicate mild laryngeal spasm or light anaesthesia.
The mask may leak slightly for the first three or four breaths before settling into position in the pharynx. In case
leakage persists, check that there is adequate depth of anaesthesia and that the pulmonary inflation pressures are
low before assuming that reinsertion of the Ambu AuraOnce is necessary.
As with other methods of airway management, use of pulse oximetry and capnography is recommended when
using the Ambu AuraOnce. The mask can be used for either spontaneous or controlled ventilation.
WARNING
• Any signs of airway problems or inadequate ventilation must be monitored regularly and the Ambu AuraOnce
must be replaced or removed as required to maintain a patent airway.
• During anaesthesia, nitrous oxide may diffuse into the cuff causing an increase in cuff volume/pressure.
Cuff pressure should be monitored and adjusted routinely.
• The anaesthetic breathing system must be adequately supported when connected to the Ambu AuraOnce
to avoid rotation of the mask.
• The patency of the Ambu AuraOnce should be reconfirmed after any change in the patient’s head or
neck position
7.7. Fixation
Secure the Ambu AuraOnce to the patient’s face with adhesive tape or with a mechanical tube holder suited for
this purpose. Do not use an oral Guedel airway as a bite block because it will prevent correct positioning of the
mask increasing the risk of trauma and reducing seal effectiveness. It is recommended to use a gauze bite block.
See figure i. Fixation of Ambu AuraOnce.
In order to prevent stimulation of the patient’s airway do not reposition or move the laryngeal mask during use and avoid
moving the patient during anaesthesia to prevent stimulation of the airway.

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WARNING
Avoid disturbing the mask during use.
7.8. Usage with Spontaneous Ventilation
The Ambu AuraOnce is suitable for spontaneously breathing patients when used with volatile agents or intravenous
aesthesia on condition that anaesthesia is adequate to match the level of surgical stimulus and the cuff is not
overinflated.
Coughing, breath-holding, or movement may occur if the level of anaesthesia is inadequate for maintenance. This
may well occur following the introduction of an external stimulus such as surgery or turning the patient if the level
of anaesthesia has been misjudged. Gently assist ventilation until breathing returns.
7.9. Usage with Positive Pressure Ventilation
Before using the Ambu AuraOnce with positive pressure ventilation (PPV), the operator should first acquire
experience in its usage in spontaneously breathing patients.
Choose a ventilatory pattern giving peak airway pressures less than 20 cmH2O and tidal volumes less than 8 ml/kg
while the capnography is closely monitored.
In the event of leakage occurring during PPV, check for the following:
• light anaesthesia causing a degree of glottis closure
• inadequate neuromuscular block
• a reduction in lung compliance related to the surgical or diagnostic procedure
• displacement of the Ambu AuraOnce by head turning or traction.
After identifying the cause of the leakage, take appropriate corrective measures.
If leakage should occur around the cuff, do not simply add more air. This will not necessarily improve the seal
pressure and may even increase the leak by adding tension to the normally soft cuff, pushing it away from the
larynx. Instead remove the mask and reinsert while providing that anaesthetic depth is adequate.
7.10. Critical observations during use
Inadequate level of anaesthesia: The most likely problem following insertion is failure to maintain an adequate
level of anaesthesia. Administer an additional bolus of induction agent and/or increase the concentration of volatile
agent while gently assisting ventilation.
Incorrect positioning of the Ambu AuraOnce can be assessed by capnography, the observation of equal
movements or by observation of changes in tidal volume, e.g. a reduction in expired tidal volume. If you suspect
that the Ambu AuraOnce has been positioned incorrectly, remove and reinsert – and provide that anaesthetic depth
is adequate.
Unexpected regurgitation: Regurgitation may occur even in fasted patients. This may be caused by inadequate
level of anaesthesia. One early sign of regurgitation is the appearance of fluid travelling up the Ambu AuraOnce
airway tube. The first signs of regurgitation may be spontaneous breathing, coughing or breath-holding.
If regurgitation occurs, provided that oxygen saturation remains at acceptable levels, the Ambu AuraOnce should
not be removed. This should be managed by putting the patient in a “head-down” position. Briefly disconnect
the anaesthetic circuit so that the gastric contents are not forced into the lungs. Check that anaesthetic depth is
adequate and deepen anaesthesia intravenously, if appropriate.

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Apply suction through the mask’s airway tube and through the mouth. Suction of the tracheobronchial tree using a
fiberscope through the mask may be employed if the airway reflexes are adequately obtunded.
If clinically indicated, commence preparation for immediate tracheal intubation. If aspiration has occurred, the patient
should be given a chest X-ray and be treated with antibiotics, physiotherapy, and tracheal suction, as appropriate.
WARNING
If airway problems persist or ventilation is inadequate, the Ambu AuraOnce should be removed and the airway
managed as clinically indicated.
7.11. Recovery
On completion of surgery, the supraglottic airway (SGA) should be removed only after the patient’s protective
reflexes have returned and the patient responds to verbal commands.
Patient monitoring should continue throughout the recovery stage. Oxygen should be continuously administered
through the anaesthetic circuit or via a T-piece. If suction is required around the oral cavity or down the airway
tube, it should be carried out prior to recovery of reflexes.
7.12. Removal procedure
Removal should always be carried out in an area where suction equipment and the facility for rapid tracheal
intubation are available.
Do not fully deflate the cuff until after its removal to avoid secretions entering the larynx and to prevent laryngospasm.
Alternatively, it may be removed moderately inflated to aid complete removal of secretions.
If the mask is to be removed in the Post-Anesthesia Care Unit, recovery room staff should receive thorough training
in all aspects of the Ambu AuraOnce.
WARNING
The sterile Ambu AuraOnce is for single use only. Destroy after use.
Do not re-sterilise.
8. Specialized use
8.1. Intubation through the Ambu AuraOnce
It is recommended to use an exchange catheter for intubation through the Ambu AuraOnce.
A flexible fiberscope can be used through the Ambu AuraOnce to view the airway. It is important to pre-oxygenate
the patient and to use standard monitoring procedures. Fiberoptic intubation via the Ambu AuraOnce can be done
using an exchange catheter.
The Ambu AuraOnce is inserted and an exchange catheter is threaded over the fiberscope. The fiberscope is
inserted until carina is seen and the exchange catheter is “railroaded” and left in the trachea.
The Ambu AuraOnce is removed. The ET-tube is put onto the exchange catheter and “railroaded” down into the
trachea. The exchange catheter is removed.
CAUTION
We do not recommend removing the airway connector on the Ambu AuraOnce.

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8.2. Use of the Ambu AuraOnce for blind tracheal intubation
There is currently no published data on blind tracheal intubation through the Ambu AuraOnce. We have no clinical
evidence to verify success rate and useful technique. We can therefore not recommend blind tracheal intubation
through Ambu AuraOnce.
8.3. Pediatric use
The Ambu AuraOnce comes in four different sizes for infant/pediatric patients. See Table 3 for selection guidelines
and maximum inflation volumes.
It is recommended that the Ambu AuraOnce in neonates and small children is used by an clinician familiar with
pediatric anesthesia.
The insertion of the Ambu AuraOnce in pediatric patients can be performed in the same way as described for
adults following either intravenous or gaseous induction. It is important that an adequate level of anesthesia
(or unconsciousness) is achieved before insertion. The insertion should be successful at the same level of anesthesia
that would be suitable for tracheal intubation. If the clinician wishes to intubate the child via the AuraOnce it is
recommended that an exchange catheter is used over a fiberscope.
Please note that with the Ambu AuraOnce, as with any form of airway management and anesthesia in pediatric
patients, where ventilation is insufficient, desaturation is likely to occur faster because of the higher oxygen
consumption of pediatric patients.
8.4. Critical situations and emergencies
8.4.1. Critical situations
The Ambu AuraOnce is not intended for use as a replacement for the endotracheal tube. However, in cases where
tracheal intubation is not suitable or has failed, the Ambu AuraOnce may be used successfully to establish an airway.
8.4.2. Emergencies
The Ambu AuraOnce may be used during cardiopulmonary resuscitation, either as a temporary rescue airway or as
a conduit to intubation. In the resuscitation situation, the patient must be profoundly unconscious with obtunded
airway reflexes. The risk of regurgitation and aspiration must be balanced against the potential benefit of
establishing an airway and providing oxygenation.
8.5. Magentic Resonance Imaging (MRI)
The Ambu AuraOnce has been determined to be MRI safe and compatible. That is, when placed in a patient
undergoing an MRI procedure, the Ambu AuraOnce will nor present any additional risk to the patient, neither affect
image quality.
WARNING
Care should be taken to monitor the patient carefully during MRI to ensure that correct positioning of the
tube is maintained.

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c
e
1
2
6
5
4
3
7
<3 0m l
<60cm H
2
O
50-70 kg
#4
d
A
J
I
K
H
G
D
C
B
F
E
26
5
4
3
1

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g
i
h
f

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LATEX
FREE
LATEX
ATE
No latex. Stated when products are latex free.
Single use only
Caution, consult accompanying documents
Use by date
Traceable number
Catalogue number/Catalog number
LOT
REF
© Copyright 2008 Ambu A/S, Denmark. All rights reserved.
No part of this programme or the programme documentation may be reproduced in any form,
including photocopying, without the prior written permission of the copyright owner.
This product information may be updated without futher notice.
Copies of the current version are available from the manufacturer.

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& Manufacturer:
Ambu A/S
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Denmark
Tel.: [phone]
Fax: [phone]
www.ambu.com
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497 3600 01 - 11/2008 - Version 1.0.1
Ambu A/S
Baltorpbakken 13
DK-2750 Ballerup
Denmark
T [phone]
F [phone]
www.ambu.com
0086
LATEX
FREE
LATEX
ATE
Pat. Pending