Me. Warner et al., DIABETES-MELLITUS AND DIFFICULT LARYNGOSCOPY IN RENAL AND PANCREATIC TRANSPLANT PATIENTS, Anesthesia and analgesia, 86(3), 1998, pp. 516-519
Limited mobility of the cervical spine or temperomandibular joint may
contribute to increased difficulty of laryngoscopy in patients who hav
e severe diabetes mellitus. The frequency of difficult laryngoscopy in
diabetics undergoing renal and/or pancreatic transplants has been rep
orted to be as high as 32%. We retrospectively reviewed the anesthetic
records of all adult patients who underwent renal and/or pancreatic t
ransplant and endotracheal intubation from January 1, 1985 to October
31, 1995. Characteristics specifically reviewed included the presence
of diabetes mellitus, type of organ donor, age, gender, body mass inde
x, previous difficult laryngoscopy, known characteristics potentially
related to difficult laryngoscopy, and degree of difficulty with laryn
goscopy. Laryngoscopy was graded as easy, minimally to moderately diff
icult, and moderately to extremely difficult to perform. Factors assoc
iated with any degree of difficult intubation were univariately assess
ed by using Fisher's exact test. Of 725 patients, 15 (2.1%) were ident
ified as having difficult laryngoscopies, although all underwent succe
ssful endotracheal intubations. Factors associated with difficult lary
ngoscopy were diabetes mellitus (P = 0.002) and characteristics known
to be related to difficult laryngoscopy (P = 0.02). These findings con
firm an increase in the frequency of difficult laryngoscopy in diabeti
c patients undergoing renal and/or pancreatic transplant, although no
laryngoscopies were rated as moderately to extremely difficult. We con
clude that the frequency of difficult laryngoscopy in these diabetic p
atients is much lower than previous reports have suggested. Implicatio
ns: Previous studies have suggested that airway management of many dia
betic patients may be difficult. Our medical record review of patients
with severe diabetes undergoing organ transplants showed that extraor
dinary techniques were not required to successfully manage their airwa
ys.