Assessment of Difficult Endotracheal Intubation in Diabetes Mellitus: A Clinical Observational Study

Abstract

Diabetes mellitus (DM) is a chronic metabolic condition that poses significant problems to anesthesiologists in the management of airways. Constant hyperglycemia creates biochemical modifications in collagen to the momentum of rigidness of tissue and less elasticity of atlanto-occipital joint. This restriction, combined with a decrease in the range of mouth opening and stiff joint syndrome, predisposes diabetic patients to problematic laryngoscopy and intubation. Widespread clinical bedside signs, including the palm print and prayer signs, and traditional examinations, including Mallampati grading, thyromental distance, and sternomental distance, are used to forecast airway difficulty, but none of these assessment techniques is completely accurate. The recent findings indicate that patients with chronic diabetes and particularly those under insulin treatment usually exhibit elevated Cormack-Lehane grades, necessitate repeat attempts to be made when intubating a patient, and are those who require sophisticated procedures like video laryngoscopy. Difficult intubation in diabetic patients has also been reported at 2731% and this is significantly higher than the general population. Preoperative assessment and preparation to deploy alternative airway devices are thus quite important in order to reduce complications and enhance patient safety in the high-risk cohort. Keywords

diabetes mellitus; difficulty in airways; Intubation; Mallampati grading; prayer sign; palm print sign; joint stiffness; CormackLehane classification; video laryngoscope; anesthesia safety.