Diabetes mellitus and difficult laryngoscopy in renal and pancreatic transplant patients

Evaluation of Palm Print Sign and Prayer Sign in Prediction of Difficult Laryngoscopy in Diabetic Patients

Background

Laryngoscopy or endotracheal intubation in diabetic patients due to impaired mobility of the Atlanto-occipital joint owing to non-enzymatic glycosylation in connective tissue has always been a problem. A difficult laryngoscopy can disrupt the intubation process; therefore, it is valuable to predict difficult laryngoscopy using some anatomical criteria before general anesthesia.

Objectives

The present study discussed the diagnostic value of two tests, palm print sign and prayer sign, in the prediction of laryngoscopy difficulty.

Methods

Design: A diagnostic test and cross-sectional analytical design were used in this study. Setting: The study population included 200 patients with type 2 diabetes who were candidates for surgery under general anesthesia. Before surgery, the patients were examined regarding the airway status, Mallampati classification, head extension rate, thyromental distance, body mass index, upper lip biting test, and two palm print sign and prayer sign tests. All the diagnostic tests were compared to the Cormack test result for difficult airways regarding their sensitivity and specificity in difficult laryngoscopy.

Results

The highest sensitivity was related to the Mallampati test, prayer sign test, and palm print sign test (100%). Furthermore, the mouth-opening test had the highest specificity (100%). The highest accuracy was reported for Mallampati, palm print sign, and prayer sign tests (> 86%).

Conclusions

Among the tests studied to predict difficulty in laryngoscopy in diabetic patients, Mallampati and palm print sign tests have good sensitivity, specificity, and accuracy. Studies with a larger sample size are suggested to obtain more accurate results.

[Aspects of perioperative care in patients with diabetes]

Diabetes is a common disease in Germany. Due to diabetes-associated end-organ disease, such as large and small vessel disease and neuropathy, diabetic patients require more intense anesthesia care during the perioperative phase. An in-depth and comprehensive medical history focusing on hemodynamic alterations, gastroparesis, neuropathy and stiff joint syndrome is a cornerstone of perioperative care and may affect outcome of diabetes patients more than specific anesthetic medications or the anesthetic procedure. Intraoperative anesthetic care needs to focus on preservation of hemodynamic stability, perioperative infection control and maintenance of glucose homeostasis. Whereas some years ago strict glucose control by aggressive insulin therapy was adamantly advocated, the results of recent studies have put the risk of such therapeutic algorithms into perspective. Therefore, optimized perioperative care of diabetic patients consists of setting a predefined targeted blood glucose level, evidence-based therapeutic approaches to reach that goal and finally adequate and continuous monitoring and amendment of the therapeutic approach if required.

The causes of difficult tracheal intubation and preoperative assessments in different age groups

Background

We studied the differences in airway assessment factors among old, middle, and young age groups, and evaluated the frequency and causes of difficult intubation among these groups.

Methods

Patients were divided into young (< 40 yr, n = 75 ), middle (40-59 yr, n = 83), and old (≥ 60 yr, n = 89) group. Airway assessment factors such as head and neck movement, thyromental distance, interincisor gap, dentition, Mallampati score, and Arné score were assessed. After muscle relaxation, cervical joint rigidity and Cormack-Lehane (C-L) grade were assessed. The differences in airway assessment factors between difficult (C-L grade 3, 4) and easy (C-L grade 1, 2) intubation were then examined. Logistic regression analysis was also carried out to identify the extent to which airway assessment factors reflected difficult intubation.

Results

As aging, head and neck movement, thyromental distance, and interincisor gap decreased, the grade of dentition, Mallampati score, cervical joint rigidity and the ratio of Arné score > 11 increased. In the old and middle group, the incidence of difficult intubation was increased compared with the young group. Dentition in the young group, Mallampati score and interinsisor gap in the middle group and Mallampati score, cervical joint rigidity in the old group respectively predicted difficult intubation.

Conclusions

Compared to young individuals, middle-aged or elderly adults are likely to experience more difficulty in endotracheal intubation and its predictive factors could vary by age group.

Anesthetic considerations in diabetic patients. Part I: preoperative considerations of patients with diabetes mellitus

Diabetes mellitus is an increasingly common disease that affects people of all ages, resulting in significant morbidity and mortality. Diabetic patients require perioperative care more frequently than their nondiabetic counterparts. The major risk factors for diabetics undergoing surgery are the associated end-organ diseases: cardiovascular disease, autonomic neuropathy, joint collagen tissue, and immune deficiency. Physicians need to pay extra attention to preoperative and preprocedure evaluation and treatment of these diseases to ensure optimal perioperative management.

[Anesthesia in surgery in patients with diabetes mellitus]

Pojava diabetes mellitusa se u zadnjih 30 godina stalno povecava, kako kod odraslih, tako i kod dece. Svetska zdravstvena organizacija procenjuje da ce se broj bolesnika sa diabetes mellitusom povecati sa sadasnjih 150 miliona na 213 miliona do kraja 2010. godine. Dijagnoza diabetesa mellitusa ne postavlja se tesko ukoliko su ispoljeni osnovni simptomi, kao sto su pojacan osecaj zedji, poliurija, polifagija i povecana koncentracija glukoze u krvi. Uzorak krvi se uzima ujutru na prazan stomak. Postupak se ponavlja 2 puta. Granicna vrednost glikemije je 7,8 mmol/l. Ukoliko nije utvrdjena povecana vrednost glukoze u krvi, a postoje ostali simptomi diabetes mellitusa, neophodno je uraditi test opterecenja glukozom.

Diabetes mellitus and anaesthesia

Diabetes mellitus is the most common endocrinological problem encountered by an anaesthetist and its prevalence will increase greatly in the next decade. This review focuses on the relevance of a new classification and diagnostic criteria for diabetes and the results of the important UK prospective diabetes study group trial. Other key areas of interest are the acute treatment of non-insulin-dependent diabetes (type 2), the management of coronary heart disease and vascular reactivity in patients with diabetes.