Preoperative Prediction of Difficult Laryngoscopy in Diabetic Patients: Importance of the Palm Print Test

Mongi Slim Hospital150 enrolled

Overview

The investigators assessed upper airway management at the pre-anaesthetic consultation using the usual clinical criteria. On the day before surgery, diabetic patients were assessed for the palm print sign to predict difficult laryngoscopy. After induction of anesthesia, laryngoscopy was performed with a Macintosh metal laryngoscope blade. At this stage of the study, patients were categorized into two groups: difficult and easy laryngoscopy.

During pre-anesthesia consultation, all participants were assessed for airway conditions using usual clinical tests (Mallampati classification, Thyromental distance, mouth-opening test, upper lip biting test (ULBT), Head extension and Prayer sign). Demographic characteristics, diabetes duration, Blood glucose regulation and diabetes-related complications were also recorded. On the day before surgery, patients were assessed for the palm print sign during preoperative evaluation rounds. On the day of surgery, after an intravenous line (IV) and complete monitoring, induction of anesthesia was initiated, and a muscle relaxant was used to facilitate intubation. Laryngoscopy was performed with a Macintosh metal laryngoscope blade by an anesthesiologist who had more than 2 years of intubation experience. McGrath® videolaryngoscope, McCoy laryngoscope, LMA Fastrack®, or i-gel® airway were kept ready for emergency situations. At this stage of the study, patients were categorized into two groups: difficult and easy laryngoscopy.

Study Type

OBSERVATIONAL

Enrollment

150

Conditions

Difficult Laryngoscopy Diabetes Preoperative Period

Interventions

the palm print testDIAGNOSTIC_TEST

The patient's dominant hand was pressed firmly against a blue ink pad, then onto a white sheet of paper without applying body weight. The palm prints were scored as follows: * Grade 0: All phalangeal areas visible * Grade 1: Deficiency in the interphalangeal areas of the 4th and 5th digits * Grade 2: Deficiency in the interphalangeal areas of the 2nd to 5th digits * Grade 3: Only the tips of the digits visible The palm print test was scored from 0 to 3. Grades 2 and 3 were considered indicators of difficult intubation.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * diabetes mellitus * aged more than 18 years * undergoing surgery under general anesthesia with endotracheal intubation. Exclusion Criteria: * physical or intellectual disabilities preventing cooperation * Malformations, trauma, tumors, or infections of the maxillofacial region and upper airways, * a history of burns or cervicofacial irradiation * neurosurgical conditions causing temporomandibular pseudoankylosis. * hand joint stiffness (e.g., carpal tunnel syndrome, Dupuytren's disease, scleroderma, rheumatoid arthritis) * restricted cervical mobility (due to osteoarthritis, ankylosing spondylitis, or cervical trauma), * a history of difficult intubation * pregnancy (including up to six weeks postpartum)

Locations (1)

Mongi Slim University Hospital

Tunis, Tunisia

Outcomes

Primary Outcomes

Difficult laryngoscopy

Cormack and Lehane graded I to IV. Grades III or IV showed difficult laryngoscopy.

Time frame: after induction of anesthesia and during laryngoscopy

Secondary Outcomes

Difficult intubation

Need of more than 2 laryngoscopies to intubate the patient

Time frame: at induction of anesthesia

Data from ClinicalTrials.gov

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