The palm print and prayer sign as a predictor for difficult laryngoscopy in diabetic patients and comparison with non-diabetic patients

Introduction: In diabetic patients, due to “stiff joint syndrome,” the incidence of difficult laryngoscopy is higher. It can be predicted by the ‘palm print sign’ and the ‘prayer sign’. These tasks, per journal policies, can be valuable in predicting difficult laryngoscopy in non-diabetic patients as well. Material and Methods: 116 adult patients, operated under general anesthesia with endotracheal intubation, were enrolled into GROUP-D, patients with diabetes mellitus ≥5 years, and GROUP-N, patients without diabetes. Preoperatively, modified Mallampati class, thyromental distance, mouth opening, neck extension, dentition, palm print grade, and prayer sign were recorded. Cormack Lehane grade was recorded at the time of laryngoscopy. Statistical analysis was performed using Fisher's exact test. Results: Incidences of difficult laryngoscopy were 44.9% and 15.5%, in diabetics and non-diabetics, respectively. In the diabetic group, palm print grade, prayer sign, and dentition had 100% sensitivity, and thyromental distance had 98.2% specificity in predicting difficult laryngoscopy. In the nondiabetic group, the palm print sign, degree of head extension, and dentition had 100% sensitivity, and the prayer sign had 100% specificity. HbA1c levels were associated with higher palm print score and difficult laryngoscopy. Conclusion: Palm print grade and Prayer sign assessment are valuable tools to predict difficult laryngoscopy in diabetic patients, as well as equally useful in non-diabetic patients.