EVALUATION OF DIFFERENT AIRWAY TESTS IN PREDICTING DIFFICULT AIRWAY IN ELDERLY DIABETIC AND NON- DIABETIC PATIENT’S UNDERGOING SURGERY UNDER GENERAL ANAESTHESIA

Abstract

Introduction: Diabetes mellitus is associated with changes in connective tissue and joint mobility that may affect airway anatomy and increase the risk of difficult intubation. The purpose of this research was to investigate and compare the effectiveness of several airway assessment measures in forecasting problematic airways among older diabetic and non-diabetic individuals having general anaesthesia. Methods: This prospective observational study included “92 diabetic and 92 non-diabetic patients aged ≥60 years scheduled for elective surgery under general anaesthesia. Preoperative airway assessment included Modified Mallampati Score (MMS), Upper Lip Bite Test (ULBT), and Palm Print Sign (PPS). Intraoperative findings of Cormack-Lehane grading, number of intubation attempts, time taken for intubation, and need for alternative methods were recorded. The predictive value of each airway test for difficult laryngoscopy was analysed. Results: Demographic profiles were comparable between groups. Class III ULBT was significantly more prevalent in diabetic patients (38.0% vs. 4.3%, p < 0.001), as were difficult Palm Print Sign grades (26.1% vs. 7.6%, p = 0.001). Difficult laryngoscopy was encountered in 34.8% of diabetic patients compared to 17.6% of non-diabetic patients (p = 0.010). Prolonged intubation time (>1 minute) was significantly more frequent in diabetic patients (10.9% vs. 3.3%, p = 0.048). In diabetic patients, ULBT demonstrated the highest sensitivity (90.6%) and excellent specificity (90.0%) for predicting difficult laryngoscopy, followed by MMS (sensitivity 75.0%, specificity 100%) and PPS (sensitivity 65.6%, specificity 95.0%). In non-diabetic patients, MMS showed the highest sensitivity (75.0%), while ULBT and PPS had lower sensitivity but excellent specificity. xvi Conclusion: Elderly diabetic patients have a significantly higher incidence of difficult laryngoscopy and prolonged intubation time compared to non-diabetic patients. Upper Lip Bite Test is the most sensitive predictor of difficult laryngoscopy in elderly diabetic patients, while Modified Mallampati Score performs better in non-diabetic patients”. Comprehensive preoperative airway assessment using multiple tests is recommended for elderly diabetic patients to anticipate and manage difficult airways effectively