Airway assessment of diabetic patients at a central hospital

Abstract

Background: Diabetic patients have been shown to have a higher incidence of difficult laryngoscopy. The aim of this study was to assess the airways of diabetic patients at Charlotte Maxeke Johannesburg Academic Hospital using the El-Ganzouri risk index (EGRI) score. Methods: A prospective, contextual, descriptive research design using consecutive convenience sampling was used. The study population consisted of patients presenting to the Diabetic Clinic. The EGRI score and the prayer sign were assessed on 189 patients. Patient characteristics, risk factors and diabetic control parameters were documented. Results: Seven (3.7%) patients had an EGRI score of ≥ 4 and 3 (1.6%) had a positive prayer sign, indicating a potentially difficult laryngoscopy. A higher percentage of non-insulin-dependent diabetic patients (14.3%) had an EGRI score ≥ 4, when compared to insulin-dependent diabetic patients (1.9%) (p = 0.010). Patients with an EGRI score ≥ 4, had a significantly higher weight than those patients with an EGRI score < 4 (p = 0.003). Of the 7 patients with an EGRI score >4, 6 were classified as Mallimpati class III. There was no significant difference between the annual average HbA1c (p = 0.194) and serum creatinine (p = 0.972) in patients with EGRI score < 4 versus ≥4. There was no significant difference in EGRI score outcome when comparing categories: estimated glomerular filtration rate (p = 0.356), urine albumin-creatinine ratio (0.108), duration of diabetes (p = 1.000) and in annual average HbA1c (p = 0.2375) between the categories of duration of diabetes. Conclusion: The majority of diabetic patients assessed in this study are not at risk for difficult laryngoscopy based on the EGRI. The variables mainly responsible for a high EGRI score in this population were weight and a Mallampati class III. No preoperative airway assessment has been shown to be 100% sensitive for a difficult airway. Further research needs to be conducted to ascertain if the findings of the EGRI in this population group translate into practice