Abstract
Background: Early securing of the airway at the induction of anaesthesia is imperative in patients at risk, making preoperative identification of the diabetics with difficult airway decisive. Diabetic patients are susceptible for limited joint mobility syndrome. Involvement of atlantooccipital joint limits adequate extension of head and neck during laryngoscopy leading to difficult intubation. The collagen glycosylation is first noted in the fourth and fifth inter-phalangeal joints leading to inability to approximate the palms and fingers of the hand. The palmprint has been used to objectively assess the degree of inter phalangeal joint involvement. A palm print score from 0-3 based on the degree of visibility of phalangeal areas on a piece of paper is assessed as a predictor of difficult laryngoscopy. The aim of our study was to evaluate the effectiveness of palm print sign as a screening tool for predicting difficult laryngoscopy in diabetic patients. '
Methods: Preoperatively, airway of 267 patients were assessed by the investigator, while they were sitting upright in a chair using the modified Mallampati test, thyromental distance, degree of head extension and the palm print test. Palm print is obtained by taking the ink impression of the dominant hand palm. Their corresponding Cormack- Lehane score [Gold standard] were noted at the time of intubation by the attending anaesthesiologist. He was blinded to the results of preoperative airway evaluation. Cormack lehane 3 or 4 view, Palm print grade 2, Mallampati grade 3 and 4, Thyromental distance grade 0,Head extension grade 1 were defined as predictors of difficult intubation. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of each were compared to get the results.
Conclusion: The PP test seems to be the most sensitive and specific tool in the prediction of difficult laryngoscopy among diabetic patients.
Keywords: Palm print sign, Diabetic, Difficult laryngoscopy.
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Corresponding Author
Dr Sandhya M S
Asst. Professor, Dept. of Anaesthesiology, Government Medical College, Thirvananthapuram, Kerala, India
DOI: https://dx.doi.org/10.18535/jmscr/v6i9.127
