Sensitivity of palm print sign in prediction of difficult laryngoscopy in diabetic patients: A comparison with other airway indices
Dr. Sheetal Shah, Dr. Bhavin Chudasma, Dr. Prachi Jadawala, Dr. Amisha Patel
Background: Patients with diabetes mellitus may have limitation in joint mobility due to non–enzymatic glycosylation of collagen and its deposition in the joints. From “Palm Print Sign”, we can assess the degree of inter-phalangeal joint involvement. The purpose of this study is to compare and evaluate sensitivity & specificity of palm print sign & commonly used airway indices to predict difficult laryngoscopy and therefore difficult intubation in diabetic patients and if there is an association between duration of diabetes mellitus & difficult laryngoscopy. Methods: Airway of 60 adult diabetic patients, undergoing elective surgery under general anaesthesia was assessed pre-operatively using Modified Mallampati test (MMT), Thyromental distance (TMD), Degree of head extension (HE) & Palm print sign (PP). Comparison of these data with Cormack-Lehane score at the time of laryngoscopy were done to decide the accuracy of these tests in predicting difficulty in intubation. Results: In our study, Palm Print Sign was most specific among 4 indices to predict difficult laryngoscopy. It has highest positive predictive value, which is very important as it is the percentage of correctly predicted difficult intubations as a proportion of all predicted difficult intubations. Conclusion: Though all the tests have their place in armamentarium of the anaesthesiologist, palm print is the best single predictor of a difficult laryngoscopy and intubation, with highest positive predictive value and is most specific.