Evaluation of Airway and Predicting Difficult Endotracheal Intubation in Diabetic Patients- A Comparison With Nondiabetic Patients

Abstract

BACKGROUND The aim of this study is to evaluate the various clinical parameters of airway assessment and their ability to predict difficult laryngoscopy and intubation in diabetic patients as compared to nondiabetic patients. MATERIALS AND METHODS Out of 120 patients, 60 diabetics (group-D) and 60 nondiabetics (group-N) were studied preoperatively for various airway indices such as the modified Mallampati Test (MPC), Thyromental Distance (TMD), Degree of Head Extension (HE), the Palm Print Index (PP) and the Prayer Sign (PS) and their corresponding Cormack-Lehane scores (CL) were noted. The two groups were studied using chi-square tests. p<0.05 was considered statistically significant. RESULTS The incidence of difficult laryngoscopy as indicated by CL grade III and IV in diabetic patients was 43.33%, while that in the nondiabetic group was 20%. In diabetics group, MPC as a predictor was more sensitive (80.77%) while PP index was more specific (97.06%). PP index also had maximum positive predictive value and odds ratio. In nondiabetic group, MPC had maximum sensitivity (75.00%) while PP index, PS and TMD were showed equal specificity (95.83%). CONCLUSION MPC as a predictor was more sensitive in both groups while PP index was more specific in group D.

Comparison of Modified Mallampati Classification in Supine and Sitting Positions to Predict Difficult Tracheal Intubation in Diabetic Patients

“…However, Gondane et al and Thomas and Hashim reported slightly lower specificities of 41.18% and 68.1% by Mallampati grading in the sitting position, respectively ( 9 , 10 ). Baig and Khan reported a specificity of 99.2% among the diabetic population, which was comparable to our finding ( 14 ).…”

“…Gonadane et al conducted a study among the diabetic population and found that Mallampati grading in the sitting position detected 21 out of 26 difficult cases with a sensitivity of 80.77% ( 9 ). In contrast, Thomas and Hashim reported that Mallampati grading could not predict difficult intubation and suggested that Palm Print was a better predictor ( 10 ).…”

“…Additionally, the specificity of the supine position was 63.6% due to a higher number of False Positive cases, while the sitting position demonstrated a specificity of 89.1%, indicating correct detection of 98 out of 110 easy intubation cases. Gonadane et al conducted a study among the diabetic population and found that Mallampati grading in the sitting position detected 21 out of 26 difficult cases with a sensitivity of 80.77% (9). In contrast, Thomas and Hashim reported that Mallampati grading could not predict difficult intubation and suggested that Palm Print was a better predictor (10).…”

Clinical Nutrition in Diabetes Mellitus with 3rd Degree Burns and Foot Ulcer as Complicated

“…The big three diabetes signs are polyuria and polydipsia (due to the osmotic effects of glucose, hyperglycemia causes elimination of glucose with water from the kidney, causing feeling of thirst), the 3 rd sign is Polyphagia due inability of the cells to take up glucose 14 .…”

“…Results of chronic hyperglycemia are: Microvascular (retinopathy, neuropathy and nephropathy), macro vascular (hypertension and hyperlipidemia which lead to CHD) and immune dysfunction 14 . Overall, DM led to reducing phagocytosis, chemotaxis and the bactericidal capacity of the inflammatory response and therefore, hyperglycemic burn patients have a high risk for infections 15 .…”