INCIDENCE OF DIFFICULT INTUBATION IN DIABETIC PATIENTS

Abstract

Background: Diabetes mellitus (DM) is a chronic metabolic disorder that may present significant challenges in airway management during general anesthesia. Chronic hyperglycemia promotes non-enzymatic glycation of collagen, resulting in tissue stiffness, reduced joint mobility, and restricted atlanto-occipital movement. These changes, together with limited mouth opening and diabetic stiff joint syndrome, may increase the risk of difficult laryngoscopy and intubation.

Objective: To determine the incidence of difficult intubation among diabetic patients undergoing general anesthesia and identify clinical and airway-related factors associated with difficult laryngoscopy.

Methods: A prospective observational study was conducted among 140 adult diabetic patients undergoing surgery under general anesthesia at Irfan General Hospital. Participants were selected using convenience sampling. Preoperative airway assessment included Mallampati classification, neck mobility, upper lip bite test, thyromental distance, sternomental distance, prayer sign, and mouth opening. Intraoperative intubation difficulty was assessed using Cormack–Lehane grading and the number of intubation attempts. Data were analyzed using SPSS version 27. Chi-square testing and multivariate logistic regression were used to identify factors associated with difficult intubation. A p-value <0.05 was considered statistically significant.

Results: Difficult intubation occurred in 30% of patients. Significant associations were observed with longer diabetes duration (≥10 years), poor glycemic control (HbA1c ≥8%), and insulin therapy. Among airway-related factors, Mallampati Class III–IV, restricted neck movement, and limited mouth opening (<3 cm) were significantly associated with difficult laryngoscopy. In multivariate analysis, diabetes duration ≥10 years (AOR=2.34, 95% CI: 1.05–5.23), HbA1c ≥8% (AOR=2.51, 95% CI: 1.16–5.45), Mallampati Class III–IV (AOR=3.36, 95% CI: 1.52–7.45), restricted neck movement (AOR=2.66, 95% CI: 1.20–5.89), and mouth opening <3 cm (AOR=3.82, 95% CI: 1.35–10.81) were significant independent predictors of difficult laryngoscopy.

Conclusion: Difficult intubation was relatively common among diabetic patients undergoing general anesthesia. Longstanding diabetes, poor glycemic control, higher Mallampati class, restricted neck movement, and limited mouth opening were important predictors of difficult laryngoscopy. Comprehensive preoperative airway assessment and appropriate preparation for difficult airway management are recommended to improve patient safety.