title: The palm print as a sensitive predictor of difficult laryngoscopy in diabetics.
abstract: BACKGROUND
  Grading of the ink impression made by the palm of the hand has been proposed as a means of screening diabetic patients in whom tracheal intubation may be difficult because of glycosylation of both metacarpal and cervical joints. The current study was designed to test the predictability of the palm print and other airway evaluation indices in a diabetic population.
  
  
  METHODS
  83 adult, diabetic patients scheduled for surgery under general anesthesia were evaluated preoperatively using 4 physical examination indices predictive of difficult laryngoscopy and intubation: Mallampati classification, thyromental distance, head extension, and palm print. Following induction of anesthesia and neuromuscular relaxation, laryngoscopy was performed and the laryngoscopic view scored. The sensitivity, specificity and positive predictive value of each airway evaluation index was calculated.
  
  
  RESULTS
  The palm print had the highest sensitivity of all indices (100%). The other 3 indices failed to detect 9 to 13 difficult laryngoscopies.
  
  
  CONCLUSIONS
  We believe that in the diabetic population, the palm print index may be a sensitive marker of difficult intubation. It is possible that other airway evaluation indices would prove more sensitive, and have greater utility, in distinct populations as compared to when they are applied to all patients.
authors.affiliation: Department of Anesthesiology, Surgical Hospital Hermanos Amerijeiras, San Lazaro, Havana, Cuba.
authors.forename: J L
authors.initials: JL
authors.lastname: Nadal
authors.forename: B G
authors.initials: BG
authors.lastname: Fernandez
authors.forename: I C
authors.initials: IC
authors.lastname: Escobar
authors.forename: M
authors.initials: M
authors.lastname: Black
authors.forename: W H
authors.initials: WH
authors.lastname: Rosenblatt
mesh_terms: D000328:Adult; D000368:Aged; D003878:Dermatoglyphics; D003920:Diabetes Mellitus / Q000601:surgery*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity