THE PALM PRINT AS A SENSITIVE PREDICTOR OF DIFFICULT LARYNGOSCOPY IN DIABETICS

Background: Grading of the ink impression made by the palm of the hand has been proposed as a means of screening diabetic patients in whom t racheal intubation may be difficult because of glycosylation of both m etacarpal and cervical joints. The current study was designed to test the predictability of the palm print and other airway evaluation indic es in a diabetic population. Method: 83 adult, diabetic patients sched uled for surgery under general anesthesia were evaluated preoperativel y using 4 physical examination indices predictive of difficult laryngo scopy and intubation: Mallampati classification, thyromental distance, head extension, and palm print. Following induction of anesthesia and neuromuscular relaxation, laryngoscopy was performed and the laryngos copic view scored. The sensitivity, specificity and positive predictiv e value of each airway evaluation index was calculated. Results: The p alm print had the highest sensitivity of all indices (100%). The other 3 indices failed to detect 9 to 13 difficult laryngoscopies. Conclusi on: We believe that in the diabetic population, the palm print index m ay be a sensitive marker of difficult intubation. It is possible that other airway evaluation indices would prove more sensitive, and have g reater utility in distinct populations as compared to when they are ap plied to all patients. (C) Acta Anaesthesiologica Scandinavica 42 (199 8).