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Biomedical subjects

C Hagberg

Publications and source records attributed to C Hagberg.

At least 19 recordsLinked to original sources
PubMed2005

The laryngeal tube for difficult airway management: a prospective investigation in patients with pharyngeal and laryngeal tumours.

BACKGROUND AND OBJECTIVE: Since the introduction of the laryngeal mask into clinical practice, various additional supraglottic ventilatory devices have been developed. Although it has been demonstrated that the laryngeal tube is an effective airway device during positive pressure ventilation no clinical study has been performed thus far regarding its use in patients with predicted ventilation and intubation difficulties. METHODS: The aim of this study was to prospectively evaluate the use of the laryngeal tube for temporary oxygenation and ventilation in adult patients with supraglottic airway tumours scheduled to undergo a pharyngeal-laryngeal oesophagoscopy and bronchoscopy under general anaesthesia. In addition to our standard airway management with face mask ventilation and rigid bronchoscopy, all patients were temporarily ventilated with an laryngeal tube. Also, in patients requiring laryngeal biopsies, endotracheal intubation was performed with a 6.0 mm microlaryngeal tracheal tube. Minute ventilation volumes, tidal volumes, ventilation pressures, end-expiratory CO2 concentration, oxygen saturation and arterial blood gas samples were measured. RESULTS: From 54 enrolled patients only patients with relevant tumour masses were evaluated (n = 23). Mask ventilation was performed without difficulty in 15 of 23 patients. Mechanical ventilation with the laryngeal tube was possible in 22 of 23 patients with an audible leak present in three. Conventional endotracheal intubation was successfully performed in 19 of 23 patients. During face mask ventilation, minute volume, tidal volume, ventilation pressure, end-tidal CO2, oxygen saturation and arterial PO2 were significantly lower and PCO2 significantly higher (P < 0.05, paired t-test). No statistically significant differences were noted between the laryngeal tube and the microlaryngeal tracheal tube. CONCLUSIONS: The possibility of difficult ventilation and intubation must always be considered, in patients with supraglottic airway tumours. In these cases, the laryngeal tube can be considered for routine airway management and may be useful in the 'cannot-intubate' situation although difficulties should be anticipated in patients with previous irradiation, specifically of the throat area.

Adult↗
PubMed2004

Risk factors assessment of the difficult airway: an italian survey of 1956 patients.

Over the last decade, there has been a heightened awareness and an increase in the amount of literature being published on recognition and prediction of the difficult airway. During the preoperative evaluation of the airway, a thorough history and physical specifically related to the airway should be performed. Various measurements of anatomic features and noninvasive clinical tests can be performed to enhance this assessment. In this study we correlated the Mallampati modified score and several other indexes with the laryngoscopic view to identify anatomical and clinical risk factors related to the difficult airway. We prospectively collected data on 1956 consecutive patients scheduled to receive general anesthesia requiring endotracheal intubation for elective surgery. The Mallampati classification versus the Cormack-Lehane (C-L) linear correlation index was 0.904. A Mallampati Class 3 correlated with a C-L Grade 2 (0.94), whereas a Mallampati Class 4 correlated with a C-L Grade 3 (0.85) and a C-L Grade 4 (0.80). Operator evaluation, performed by a simplified tracheal intubation difficulty scale, showed a linear correlation of 0.96 compared with the C-L groups. Although there is a correlation between oropharyngeal volume and difficult intubation, the Mallampati score by itself is insufficient for predicting difficult endotracheal intubation.

Adult↗
PubMed2003

Difficult airway management patterns among attending anaesthetists practising in Israel.

BACKGROUND AND OBJECTIVE: In recent years, a large number of airway devices have been introduced into clinical practice as adjuncts to the management of the difficult airway. The purpose of this study was to evaluate the practices of Israeli anaesthetists in specific clinical situations and their familiarity with the use of a variety of airway devices and techniques. METHODS: A survey developed in our institution was sent to 300 attending anaesthetists representing all board-certified anaesthetists practising in Israel. RESULTS: Of the 153 respondents, 75% belonged to university hospitals. Ninety-six percent were skilled with laryngeal mask airways and 73% with fibreoptics. Seventy percent preferred regional anaesthesia with anticipated difficult intubation, continuation of anaesthesia with a laryngeal mask with failed intubation and a laryngeal mask for impossible mask ventilation. For the airway scenarios, awake fibreoptic, awake direct laryngoscopy, intubation under inhalation anaesthesia and tracheostomy were shared equally. CONCLUSIONS: There is a high degree of adherence by Israeli anaesthetists to the American Society of Anesthesiologists' difficult airway algorithm. Current airway management practice patterns in Israel are presented.

Airway Obstruction↗
PubMed2003

Prediction of difficult laryngoscopy in obese patients by ultrasound quantification of anterior neck soft tissue.

In 50 morbidly obese patients, we quantified the soft tissue of the neck from the skin to the anterior aspect of the trachea at the vocal cords using ultrasound. Thyromental distance, mouth opening, limited neck mobility, modified Mallampati score, abnormal upper teeth, neck circumference and sleep apnoea were assessed as predictors of difficult laryngoscopy. Of the nine (18%) cases of difficult laryngoscopy, seven (78%) had a history of obstructive sleep apnoea, compared with two of the 41 patients (5%) in whom laryngoscopy was easy (p < 0.001). Patients in whom laryngoscopy was difficult had more pretracheal soft tissue (mean (SD) 28 (2.7) mm vs. 17.5 (1.8) mm; p < 0.001) and a greater neck circumference (50 (3.8) vs. 43.5 (2.2) cm; p < 0.001). None of the other predictors correlated with difficult laryngoscopy. We conclude that an abundance of pretracheal soft tissue at the level of the vocal cords is a good predictor of difficult laryngoscopy in obese patients.

Adult↗
PubMed2001

The incidence of class "zero" airway and the impact of Mallampati score, age, sex, and body mass index on prediction of laryngoscopy grade.

IMPLICATIONS: In an earlier study we proposed the addition of a new airway class, zero (visualization of the epiglottis), to the four classes of the modified Mallampati classification. In this prospective study, 764 surgical patients were assessed with regard to their airway class (including class zero), laryngoscopy grade, and the effect of the airway class and other predictors on the laryngoscopy grade.

Adult↗
PubMed2001

Etiology and incidence of endotracheal intubation following spinal anesthesia for cesarean section.

BACKGROUND: The incidence of spinal failure necessitating general anesthesia and endotracheal intubation following spinal anesthesia for cesarean section is extremely low. Aspiration prophylaxis prior to spinal anesthesia is often recommended in case of spinal failure or excessive spinal block requiring the emergency administration of general anesthesia. OBJECTIVES: To determine the incidence of endotracheal intubation following spinal anesthesia for cesarean section. METHODS: We retrospectively reviewed the peri-operative course of parturients undergoing cesarean section under spinal anesthesia at our institution from February 1991 to December 1993. If spinal failure occurred, 10 ml of sodium bicarbonate was administered by mouth prior to induction of general anesthesia. RESULTS: Among the 743 cases that we reviewed, spinal failure occurred in 15 patients (2%) because of inadequate analgesia in 14 patients (1.9%) and unexpected prolonged surgery for hysterectomy in one patient (0.1%). No patient required intubation due to excessive spinal block. In none of the patients was a record of pulmonary aspiration identified. CONCLUSIONS: The extremely low incidence of spinal failure or excessive block necessitating endotracheal intubation suggests that routine aspiration prophylaxis may not be necessary prior to spinal anesthesia. However, these results should be confirmed by a prospective, controlled study on larger populations. An antacid should be readily available and administered whenever general anesthesia is required.

Adult↗
PubMed2000

Linkage analysis of candidate regions in Swedish nonsyndromic cleft lip with or without cleft palate families.

OBJECTIVE: To analyze linkage of five candidate regions for nonsyndromic cleft lip with or without palate (CLP) on chromosome 2p13, 4q, 6p23, and 19q13; in addition chromosome 1q32, the locus for van der Woude syndrome, on Swedish CLP families. DESIGN: Three to five linked microsatellite markers were selected from each candidate region. Polymerase chain reaction (PCR) with fluorescent-labeled microsatellite markers was performed on DNA samples from the participating families. Electrophoresis of the PCR products was performed on a laser-fluorescent DNA sequencer. The genotype data were analyzed with multipoint linkage analysis. Modes of inheritance tested included two autosomal dominant, an autosomal recessive, and a nonparametric model. Multipoint logarithm of odds (LOD) scores were also calculated by assuming genetic heterogeneity. PARTICIPANTS: Nineteen Swedish multigenerational families with at least two first-degree relatives affected with CLP. Greater than 50% of the families studied show vertical transmission of the clefting phenotype and both inter- and intrafamilial variability were noted. RESULTS: Cumulative multipoint LOD scores for the whole group of families calculated under autosomal dominant modes of inheritance were negative in all regions and less than -2 except chromosome 6p23. LOD scores calculated under recessive inheritance and the nonparametric model were inconclusive. There was no significant evidence of genetic heterogeneity among the sample group. CONCLUSIONS: The group of Swedish CLP families did not demonstrate significant linkage to any of the five candidate regions examined. This might suggest a new but yet unknown CLP locus or loci in this family group. However, because linkage could not be excluded in some individual families, they should still be tested with candidate genes from these regions.

Chromosome Mapping↗
PubMed1999

Clinical and genetic studies of Van der Woude syndrome in Sweden.

Van der Woude syndrome (VWS) is an autosomal dominant craniofacial disorder characterized by pits of the lower lip, hypodontia and cleft lip and/or cleft palate. It has been reported as the most common form of syndromic orofacial clefting with very high penetrance and varied expressivity. The disease locus for VWS has been mapped to chomosome 1q32, but the gene is yet to be cloned. Here we report a total of 11 Swedish VWS patients: 9 familial cases from two families and two isolated cases. Clinical examination of these patients showed phenotypic variability, even between patients from the same family. Genetic studies were performed using four microsatellite markers from chromosome 1q32. Constitutional deletion in this region was not demonstrated in any of the familial or isolated cases. However, in the two VWS families, linkage analysis using these markers showed positive LOD (logarithm of the odds) scores ranging from 2.56 to 2.88 to all individual markers. The highest LOD score of 3.75 was obtained with the combined haplotypes of D1S491 and D1S205, thus confirming linkage of VWS in these two families to 1q32. We conclude that there is varied expressivity but no evidence of genetic heterogeneity in VWS.

Anodontia↗
PubMed1998

Incidence of cleft lip and palate and risks of additional malformations.

OBJECTIVE AND METHODS: Children with cleft lip and/or palate (n = 251) born between 1991 and 1995 in the county of Stockholm, Sweden, were studied with reference to incidence and rate ratios (RRs) of different types of clefts, gender, birth weight, mother's age, and length of pregnancy. Children who had clefts and additional malformations were compared with children who had clefts but no additional malformations. RESULTS: The incidence of clefts was 2.0/1000 live births, and it was higher among males than among females. The RR, an index of relative risk, was 1.58. The main groups, children with isolated cleft lip, children with cleft lip and palate, and children with isolated cleft palate, showed similar incidence values (0.6-0.7/1000 live births). Children with bilateral clefts had an incidence of 0.3/1000 live births. Additional malformations were found in approximately every sixth newborn with a cleft when children with Robin sequence were excluded. There was a tendency for newborns with bilateral clefts to have additional malformations (RR = 1.36; confidence interval = 0.74-2.49). Children with clefts and additional malformations had lower birth weight and were born earlier than children with clefts only. CONCLUSION: Preterm cleft children with low birth weight should be screened for the presence of other birth defects.

Adult↗
PubMed1994

The alignment of permanent mandibular incisors in children. A longitudinal prospective study.

The aim was to study the alignment of mandibular incisors before and after eruption of the canines, and if possible to find a method of predicting space deficiency. Fifty-three children with normal occlusion or untreated mild post-normal occlusion had plaster models taken at 7, 9, 10, and 13 years of age. An estimation of the space situation for the mandibular incisors was made using a scale with five levels. Measurements of intercanine distance, width of each incisor and space available between the canines were made. Greater crowding was seen before the eruption of permanent canines than after the start of eruption. Estimation of space showed significant correlations to measurements of inter-canine distance. Children with an excess of incisal space had a wider mandibular inter-canine distance compared with those with a deficiency of space. Among 7-, 9-, and 10-year-old children an inter-canine distance of less than 26 mm was associated with crowding. A distance of 28 mm or more was estimated as no risk for crowding.

Child↗
PubMed1994

Musculoskeletal symptoms and psychosocial factors among patients with craniomandibular disorders.

General musculoskeletal symptoms and emotional stress situations in terms of psychosocial stressors at work and sleeping disturbances were compared between patients with craniomandibular disorders (CMD) (56 women, 24 men) and a random population sample (88 men, 86 women in the Stockholm Music 1 study). A multiple-choice questionnaire was used. In comparison with the CMD men the CMD women had an increased rate of tooth clenching and muscular pain in the face. When compared with the women in the population sample, the CMD women showed increased risks for musculoskeletal pain in various parts of the body, such as neck, shoulders, thoracic back, wrist/hands, and the knees. A comparison between the CMD men and the men in the population did not show any clear differences in prevalence of general musculoskeletal symptoms. However, the CMD men differed in reporting higher scores for psychologic demands at work and also in having more sleeping disturbances.

Adult↗
PubMed1994

The longitudinal development of malocclusion in postnormal children with little respectively urgent need for orthodontic treatment.

The development of overjet, overbite and first molar relationship was followed longitudinally in 30 children with Class II malocclusion. They received no orthodontic treatment during the 7-year registration period. Models were taken each year between 7 and 14 years of age. The need for orthodontic treatment was defined using a 4-grade treatment priority index issued by the National Swedish Board of Health. The postnormal children were classified into two groups according to the need for treatment at the time when the first model was taken (age 7). The "treatment index 1" group (= group 1) consisted of 18 mild postnormal cases with little need for treatment. The "treatment index 3" group (= group 3) consisted of 12 cases with urgent need for treatment according to the priority index. All cases were Class II:division 1 with proclined incisors. For group 1 a significant increase in overjet and overbite was found over years. No uniform pattern in the longitudinal development of overjet and overbite was found for group 3. No clear changes in the first molar relationship in either group were found. Interceptive treatment in the mixed dentition is suggested favourable in postnormal cases, even when the malocclusion initially is mild in order to avoid an increase in overjet and overbite.

Adolescent↗
PubMed1992

Shear bond strength of ceramic brackets with chemical or mechanical retention.

The study was undertaken to measure and compare the shear bond strengths of a ceramic bracket with chemical retention, a ceramic bracket with a new type of textured base providing mechanical retention, and a metal bracket with foil-mesh base. The tests were performed on 51 extracted human premolars which were randomly divided into three equally large groups (n = 17)--one group for each type of bracket. After debonding, the site of failure was noted and the enamel surface inspected with scanning electron microscopy. The ceramic bracket with chemical retention exhibited significantly higher bond strength than the corresponding bracket with textured base. In comparison with the metal bracket significantly higher bond strengths were recorded for both types of ceramic brackets. The ceramic bracket with mechanical retention and the metal bracket were comparable as regards the site of bond failure. In some cases the chemical bond provided very high values of bond strength. Enamel failure were recorded in three teeth which had been bonded with this type of ceramic bracket.

Acid Etching, Dental↗
PubMed1991

General musculoskeletal complaints in a group of patients with craniomandibular disorders (CMD). A case control study.

In a cross sectional study 30 patients with craniomandibular disorders (CMD) and 30 controls were screened for general musculoskeletal complaints. A questionnaire was used to mark the sites of the body that were painful and assessments of pain intensities in the neck, shoulders and the jaws were registered. "Pain tolerance" was clinically measured with cutaneous electrical stimulation over the masseter areas. The CMD patients had a significantly higher number of painful sites on the body than the controls. They showed significantly increased "relative risks" of having musculoskeletal pain especially in the upper neck, the shoulder and lower neck region, the shoulder joint and the thoracic back. Discomfort and pain rating values for the neck and shoulders were significantly higher for CMD patients than for controls. The measurements of "pain tolerance" did not differ between groups. However, an individual variation was found among the CMD patients. Those who had pain in many different parts of the body were the least tolerant of experimentally induced pain.

Adult↗
PubMed1990

Changes in maximum bite force related to extension of the head.

The maximum bite force and position of the hyoid bone during natural and extended head posture were studied in 15 adults. All participants had normal occlusions and full dentitions. In addition, there were no signs or symptoms of craniomandibular disorders. The bite force was measured with a bite force sensor placed between the first molars. Six registrations of gradually increasing bite force up to a maximum were made with randomized natural and extended head postures. With one exception, the mean maximum bite force value was found to be higher for every subject with extended head posture compared to natural head posture. The sample mean was 271.6 Newton in natural head posture and 321.5 Newton with 20 degrees extension. With changed head posture, the cephalometric measurements pointed towards a changed position of the hyoid bone in relation to the mandible and pharyngeal airway. The cephalometric changes in the position of the hyoid bone could be due to a changed interplay between the elevator and depressor muscle groups. This was one factor which could have influenced the registered maximum bite force.

Adult↗