Difficult Laryngoscopy and Diabetes Mellitus

Anaesthetic Implications for Parturient With Gestational Diabetes Mellitus, Thyrotoxicosis and Hypertension

“…14, 15  There exists a high association of Diabetes Mellitus with other co-morbid diseases such as HTN, CAD, pre-eclampsia, renal dysfunction, autonomic neuropathy and so many others. 16  General anaesthesia (GA) is more hazardous in these patients due to high probability of difficult airway management due to limited atlanto-occipital joint extension, exaggerated and unpredictable response to stress during intubation and impaired counter regulatory responses to fluctuating blood sugar levels. 17  Management of diabetes is challenging as the requirement of insulin increases two-fold near term gestation.…”

“…18  Regional anaesthesia is much safer than GA as responses to hypoglycemia are blunted in these patients and are difficult to diagnose under GA whereas during regional anaesthesia (RA) patient will be able to convey the things verbally. 16,19,20  The drawback in DM patients with autonomic neuropathy receiving RA includes exaggerated sympathetic response due to autonomic imbalance.  Hyperthyroidism may precipitate heart failure, and thyroid storm may occur during labour and delivery in a thyrotoxic woman.…”

Anesthetic considerations for nontransplant procedures in lung transplant patients

“…A higher incidence of unanticipated difficult intubation also has been reported in recipients with posttransplant diabetes. The "diabetes-related stiff joint syndrome" involving the atlanto-occipital joint in fact may hinder laryngoscopy [29]. Accurate physical inspection of the mouth opening, Mallampati scoring, and/or a history of several attempts at tracheal intubation during a previous surgery should be carefully considered so as to identify and/ or exclude a difficult-to-ventilate/intubate recipient.…”

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

“…Salzarulo and Taylor [11] first reported a case of difficult endotracheal intubation due to diabetic stiff-joint syndrome in 1986 in a 36-year-old man with juvenile-onset DM who could not be intubated due to severe limitation of tilting the head on the atlas. In 1988, Hogan et al [12] retrospectively examined the incidence of difficult laryngoscopy in 40 diabetic patients undergoing pancreatic transplantation and in 75 diabetic and 112 nondiabetic patients undergoing kidney transplantation. They found that 32% of the 115 diabetic patients had a difficult laryngoscopy compared with 2.7% of 112 nondiabetic patients.…”