Comparing the sensitivity of palm print sign and prayer sign in prediction of difficult intubation in diabetic patients

Abstract

Background and Aim: Palm print and prayer signs are manifestations of “limited joint mobility” syndrome caused by long-standing Type I and Type II diabetes mellitus. This study aims at finding out, which of the two signs is more sensitive for the prediction of difficult intubation in type II diabetes mellitus patients. The secondary objective is to correlate the above two signs with the Cormack–Lehane View during direct laryngoscopy and also to determine whether the duration of Type II diabetes mellitus correlates with difficult intubation in isolation. Materials and Methods: A prospective observational study was carried out in a tertiary care hospital. One hundred and fifty patients suffering from Type II diabetes mellitus, undergoing elective general anesthesia with endotracheal intubation, were enrolled in the study. The correlation between Palm print and Prayer sign with Cormack and Lehane grades was studied using the Chi-square test, continuity correction, and Fisher's exact test. The diagnostic efficacy of intubation difficulty for both the signs was assessed by calculating sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratio. Results: The palm print sign was found to be a better indicator of difficult intubation in type II diabetes mellitus patients (P < 0.01). The duration of Type II diabetes mellitus was found to be associated well with difficult intubation (P = 0.007). Conclusion: Palm print sign is the single most important test for predicting difficult intubation in Type II diabetes mellitus patients. Duration of Type II diabetes mellitus itself correlates well with difficult intubation.

Keywords

• airway management
• diabetes
• glycosylation
• laryngoscopy