DIABETES-MELLITUS AND DIFFICULT LARYNGOSCOPY IN RENAL AND PANCREATIC TRANSPLANT PATIENTS

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.