Unanticipated Difficult Laryngoscopy in a Diabetic Patient Undergoing Coronary Artery Bypass Graft Surgery

Abstract

Difficult laryngoscopy has been shown to be more frequent in cardiac surgery versus general surgery. In one study, the incidence of difficult laryngoscopy in cardiac surgery was almost double that compared to general surgery patients.1 The incidence of difficult laryngoscopy is also higher in diabetic patients, with an incidence reported to be as high as 30% in long-term diabetics.2 In Singapore, the prevalence of diabetes mellitus in patients presenting for coronary artery bypass grafting (CABG) is high and despite a seemingly normal airway examination based on head and neck examination, one may encounter unexpected difficulties. We present a 53-year-old man diagnosed with triple vessel coronary artery disease (CAD) scheduled for CABG. He weighed 64.4 kg, was 163 cm tall and had a body mass index (BMI) of 24.2. He had a significant 30-year history of juvenile onset diabetes with a fair blood glucose control demonstrated by a recent HbA1C of 7.9%. He was on a subcutaneous insulin regiment of Mixtard 34 units in the morning, 15 units at night, and oral Metformin 250 mg twice a day.