# Pectus Excavatum — GCMD Library living collection

Also covered as: pectus carinatum · Marfan syndrome · Ehlers-Danlos syndrome · chronic pain · chronic neuropathic pain · scoliosis · mitral valve prolapse · shortness of breath on exertion

Experts: Dr. Cecilia Gigena, Dr. Victor Garcia, Dr. Todd Ponsky, Dr. Ellen Encisco

Updated: n/a · 54 episodes · 912 cited statements

## Episodes
### Diagnosis & Workup
- [Pectus - Preoperative Assessment - Radiology and Cardiac Evaluation](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692) — video · 44:03 · [machine version](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692.md)
- [Pectus - Preoperative Assessment - Genetics](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691) — video · 9:54 · [machine version](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691.md)
- [Radiology: Pectus Innovations](https://qa.library.globalcastmd.com/watch/radiology-pectus-innovations-1019) — video · 38:47 · [machine version](https://qa.library.globalcastmd.com/watch/radiology-pectus-innovations-1019.md)
- [Genetics: Pectus Innovations](https://qa.library.globalcastmd.com/watch/genetics-pectus-innovations-1018) — video · 9:48 · [machine version](https://qa.library.globalcastmd.com/watch/genetics-pectus-innovations-1018.md)
- [Pectus Arcuatum a Pectus Unlike any Other](https://qa.library.globalcastmd.com/watch/pectus-arcuatum-a-pectus-unlike-any-other-7899) — video · 0:51 · [machine version](https://qa.library.globalcastmd.com/watch/pectus-arcuatum-a-pectus-unlike-any-other-7899.md)

### Surgical Management
- [Pectus Deformities: Update Course 2015](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671) — video · 34:58 · [machine version](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671.md)
- [Pectus Excavatum Pain Management at Cincinnati Children's Hospital](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693) — video · 54:09 · [machine version](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693.md)
- [Pectus Deformities: Update Course 2015](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990) — video · 34:40 · [machine version](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990.md)
- [Criteria for Pectus Repair: Update Course 2015](https://qa.library.globalcastmd.com/watch/criteria-for-pectus-repair-update-course-2015-997) — video · 0:55 · [machine version](https://qa.library.globalcastmd.com/watch/criteria-for-pectus-repair-update-course-2015-997.md)
- [Pain Management: Pectus Innovations](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015) — video · 54:09 · [machine version](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015.md)
- [Minimally Invasive Repair of Pectus Carinatum](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953) — video · 5:00 · [machine version](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953.md)
- [Minimally Invasive Repair of Pectus Carinatum](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954) — video · 5:00 · [machine version](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954.md)
- [Pectus Excavatum Pathway](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973) — video · 5:09 · [machine version](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973.md)
- [Update Course Rewind: Cryoanalgesia in Pectus Cases 2024](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194) — video · 7:34 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194.md)
- [Update Course Rewind: Part 1 Non-Pectus Uses of Cryoanalgesia 2024](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574) — video · 4:25 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574.md)
- [Update Course Rewind: Part 2 Non-Pectus Uses of Cryoanalgesia 2024](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622) — video · 4:23 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622.md)

### Complications
- [Pectus - Surgical Approaches for Failed Repair](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689) — video · 44:25 · [machine version](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689.md)
- [Interesting Cases & Surgical Approaches: Pectus Innovations](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016) — video · 44:14 · [machine version](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016.md)

### Evidence & Research
- [Pectus - Physiologic Consequences and Research](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688) — video · 22:32 · [machine version](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688.md)
- [Physiology: Pectus Innovations](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017) — video · 21:01 · [machine version](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017.md)
- [Stay Current Journal Club: Episode 1 - Ventricular Dysfunction in CDH and...](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689) — podcast · 16:50 · [machine version](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689.md)
- [APSA - Is same day discharge possible following the Nuss repair for pectus excavatum - R. Luke Rettig](https://qa.library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422) — video · 7:57 · [machine version](https://qa.library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422.md)
- [BOB Ped Surg 2023 - Joshua Ramjist, CAPS  - Presentation](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351) — video · [machine version](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351.md)
- [BOB Ped Surg 2023 - Brittany Hegde, PAPS  - Presentation](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359) — video · [machine version](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359.md)
- [Novel index to estimate the cephalocaudal extent of the excavation in pectus excavatum - JPS article](https://qa.library.globalcastmd.com/watch/novel-index-to-estimate-the-cephalocaudal-extent-of-the-excavation-in-pectus-excavatum-jps-article-6617) — video · 1:13 · [machine version](https://qa.library.globalcastmd.com/watch/novel-index-to-estimate-the-cephalocaudal-extent-of-the-excavation-in-pectus-excavatum-jps-article-6617.md)
- [Novedoso indice para estimar la extensión cefalocaudal del hundimiento esternal en el pectus excavatum: El Índice Titanic](https://qa.library.globalcastmd.com/watch/novedoso-indice-para-estimar-la-extensi-n-cefalocaudal-del-hundimiento-esternal-en-el-pectus-excavatum-el-ndice-titanic-6619) — video · [machine version](https://qa.library.globalcastmd.com/watch/novedoso-indice-para-estimar-la-extensi-n-cefalocaudal-del-hundimiento-esternal-en-el-pectus-excavatum-el-ndice-titanic-6619.md)
- [Journal of pediatric surgery Article Review: April 2023, IPEG issue](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959) — podcast · 13:22 · [machine version](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959.md)
- [Cost and outcomes of intercostal nerve cryoablation versus thoracic epidural following the Nuss procedure](https://qa.library.globalcastmd.com/watch/cost-and-outcomes-of-intercostal-nerve-cryoablation-versus-thoracic-epidural-following-the-nuss-procedure-7313) — video · 1:07 · [machine version](https://qa.library.globalcastmd.com/watch/cost-and-outcomes-of-intercostal-nerve-cryoablation-versus-thoracic-epidural-following-the-nuss-procedure-7313.md)
- [Cryoablation in 350 Nuss procedures](https://qa.library.globalcastmd.com/watch/cryoablation-in-350-nuss-procedures-7334) — video · 0:56 · [machine version](https://qa.library.globalcastmd.com/watch/cryoablation-in-350-nuss-procedures-7334.md)
- [Crioablación en 350 procedimientos de Nuss: evolución de la duración de la estancia hospitalaria y el uso de opioides](https://qa.library.globalcastmd.com/watch/crioablaci-n-en-350-procedimientos-de-nuss-evoluci-n-de-la-duraci-n-de-la-estancia-hospitalaria-y-el-uso-de-opioides-7335) — video · 0:59 · [machine version](https://qa.library.globalcastmd.com/watch/crioablaci-n-en-350-procedimientos-de-nuss-evoluci-n-de-la-duraci-n-de-la-estancia-hospitalaria-y-el-uso-de-opioides-7335.md)
- [Initial Outcomes Using Cryoablation in Surgical Management of Slipping Rib Syndrome](https://qa.library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456) — video · 1:03 · [machine version](https://qa.library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456.md)
- [Resultados iniciales del uso de crioablación en el tratamiento quirúrgico del síndrome de costilla deslizante](https://qa.library.globalcastmd.com/watch/resultados-iniciales-del-uso-de-crioablaci-n-en-el-tratamiento-quir-rgico-del-s-ndrome-de-costilla-deslizante-7467) — video · 0:57 · [machine version](https://qa.library.globalcastmd.com/watch/resultados-iniciales-del-uso-de-crioablaci-n-en-el-tratamiento-quir-rgico-del-s-ndrome-de-costilla-deslizante-7467.md)
- [Quick Literature Updates Episode 13](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-13-7638) — video · 4:12 · [machine version](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-13-7638.md)
- [Impact of Cryoanalgesia Use During Minimally Invasive Pectus Excavatum Repair on Hospital Days and Total Hospital Costs Among Pediatric Patients](https://qa.library.globalcastmd.com/watch/impact-of-cryoanalgesia-use-during-minimally-invasive-pectus-excavatum-repair-on-hospital-days-and-total-hospital-costs-among-pediatric-patients-7862) — video · 0:59 · [machine version](https://qa.library.globalcastmd.com/watch/impact-of-cryoanalgesia-use-during-minimally-invasive-pectus-excavatum-repair-on-hospital-days-and-total-hospital-costs-among-pediatric-patients-7862.md)
- [Impacto de la Crioanalgesia durante la reparación del Pectus Excavatum en la estadia hospitalaria y los costos en la población pediátrica](https://qa.library.globalcastmd.com/watch/impacto-de-la-crioanalgesia-durante-la-reparaci-n-del-pectus-excavatum-en-la-estadia-hospitalaria-y-los-costos-en-la-poblaci-n-pedi-trica-7863) — video · 0:52 · [machine version](https://qa.library.globalcastmd.com/watch/impacto-de-la-crioanalgesia-durante-la-reparaci-n-del-pectus-excavatum-en-la-estadia-hospitalaria-y-los-costos-en-la-poblaci-n-pedi-trica-7863.md)
- [Journal of Pediatric Surgery Article Review: July 2023, PAPS Issue](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900) — podcast · 10:46 · [machine version](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900.md)
- [Journal of Pediatric Surgery Article Review: September 2023](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057) — podcast · 13:31 · [machine version](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057.md)
- [Long-Term Sensory Function 3 years after Minimally Invasive Repair of Pectus Excavatum with Cryoablation](https://qa.library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729) — video · 1:19 · [machine version](https://qa.library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729.md)
- [Journal of Pediatric Surgery Article Review: Q1 (Jan-Mar) 2024](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754) — podcast · 13:34 · [machine version](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754.md)
- [Pectus Bar Dislocation: Comparison Between Three Different Stabilization Techniques Adopted in a Single Centre](https://qa.library.globalcastmd.com/watch/pectus-bar-dislocation-comparison-between-three-different-stabilization-techniques-adopted-in-a-single-centre-9184) — video · 1:02 · [machine version](https://qa.library.globalcastmd.com/watch/pectus-bar-dislocation-comparison-between-three-different-stabilization-techniques-adopted-in-a-single-centre-9184.md)
- [Six Years of Quality Improvement in Pectus Excavatum Repair: Implementation of Intercostal Nerve Cryoablation and ERAS Protocols for Patients Undergoing Nuss Procedure](https://qa.library.globalcastmd.com/watch/six-years-of-quality-improvement-in-pectus-excavatum-repair-implementation-of-intercostal-nerve-cryoablation-and-eras-protocols-for-patients-undergoing-nuss-procedure-10353) — video · 0:51 · [machine version](https://qa.library.globalcastmd.com/watch/six-years-of-quality-improvement-in-pectus-excavatum-repair-implementation-of-intercostal-nerve-cryoablation-and-eras-protocols-for-patients-undergoing-nuss-procedure-10353.md)
- [Vacuum Bell Therapy for Pectus Excavatum: Long-term Experience at a Single Center](https://qa.library.globalcastmd.com/watch/vacuum-bell-therapy-for-pectus-excavatum-long-term-experience-at-a-single-center-10404) — video · 0:58 · [machine version](https://qa.library.globalcastmd.com/watch/vacuum-bell-therapy-for-pectus-excavatum-long-term-experience-at-a-single-center-10404.md)
- [Cardiopulmonary Impact of the Minimally Invasive Repair of Pectus Excavatum in Pediatric Patients: A Prospective Pilot Study](https://qa.library.globalcastmd.com/watch/cardiopulmonary-impact-of-the-minimally-invasive-repair-of-pectus-excavatum-in-pediatric-patients-a-prospective-pilot-study-10436) — video · 0:55 · [machine version](https://qa.library.globalcastmd.com/watch/cardiopulmonary-impact-of-the-minimally-invasive-repair-of-pectus-excavatum-in-pediatric-patients-a-prospective-pilot-study-10436.md)
- [Quick Literature Updates Ep 24](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235) — video · 4:42 · [machine version](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235.md)

### In-Depth Reviews
- [An Update on Chest Wall Anomalies and Their Treatment: Advanced Practice...](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423) — video · 46:05 · [machine version](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423.md)
- [Chest Wall Deformities with Dr. Robert Kelly](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305) — podcast · 46:50 · [machine version](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305.md)
- [Update Course Rewind 2021 - Updates in Pectus](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411) — video · 61:14 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411.md)
- [Update Course Rewind: Pectus Excavatum 2021](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806) — podcast · 11:56 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806.md)
- [Update Course Rewind: Pectus Excavatum 2021](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807) — video · 11:56 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807.md)
- [Update Course Rewind: 2024 Top Ten Key Takeaways](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526) — video · 18:01 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526.md)
- [Update Course Rewind: Pectus Excavatum 2021](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668) — podcast · 11:55 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668.md)

### Patient & Family Education
- [Pectus - Patient and Family Education](https://qa.library.globalcastmd.com/watch/pectus-patient-and-family-education-690) — video · 19:07 · [machine version](https://qa.library.globalcastmd.com/watch/pectus-patient-and-family-education-690.md)
- [Patient Testimonial and Experience: Pectus Innovations](https://qa.library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014) — video · 13:55 · [machine version](https://qa.library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014.md)
- [Pectus-Patient Testimonial and Experience](https://qa.library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241) — video · 14:33 · [machine version](https://qa.library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=0) Introduction and Guest Presentation (Ep 20)
- [1:23](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=83) Patient Selection and Initial Evaluation for Pectus Excavatum (Ep 20)
- [7:20](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=440) Diagnostic Workup and Objective Criteria (Ep 20)
- [15:11](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=911) Surgical Indications and Optimal Timing (Ep 20)
- [16:47](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1007) Preoperative Counseling and Pain Management (Ep 20)
- [21:04](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1264) Nuss Procedure Technical Details (Ep 20)
- [27:23](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1643) Complications and Outcomes (Ep 20)
- [37:11](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2231) Non-operative Treatment: Vacuum Bell (Ep 20)
- [40:40](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2440) Pectus Carinatum Management (Ep 20)
- [45:15](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2715) Resources and Closing (Ep 20)
- [0:00](https://qa.library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729?t=0) Introduction and Context (Ep 43)
- [0:17](https://qa.library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729?t=17) Study Design and Methods (Ep 43)
- [0:44](https://qa.library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729?t=44) Results and Conclusions (Ep 43)
- [0:00](https://qa.library.globalcastmd.com/watch/pectus-bar-dislocation-comparison-between-three-different-stabilization-techniques-adopted-in-a-single-centre-9184?t=0) Bridge vs Single Bar Fixation for Pectus Excavatum (Ep 45)
- [0:00](https://qa.library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=0) Integrative Care and Complementary Therapies for Pectus Patients (Ep 6)
- [4:59](https://qa.library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=299) Physical Therapy Protocol and Early Mobility (Ep 6)
- [8:02](https://qa.library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=482) Preoperative Education Class and SSI Prevention Bundle (Ep 6)
- [12:15](https://qa.library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=735) Pain Management in Ehlers-Danlos Syndrome Patients (Ep 6)
- [0:00](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=0) Cincinnati's Epidural-First Approach and Patient Selection for On-Q Pumps (Ep 8)
- [4:14](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=254) Epidural Safety: Positioning, Neurological Risk Mitigation, and Infection Prevention (Ep 8)
- [7:18](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=438) On-Q Catheter Variables and Exparel Use in Adults (Ep 8)
- [11:50](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=710) Epidural Management Details: Ambulation, Foley Catheters, and Preoperative Preparation (Ep 8)
- [17:27](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=1047) Opioid Problems and Epidural Benefits: Literature Review (Ep 8)
- [21:34](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=1294) Meta-Analysis Evidence and Cincinnati vs. Kansas Outcomes (Ep 8)
- [24:25](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=1465) Cincinnati's Detailed Pain Protocol: Preoperative Through Post-Op Day 3 (Ep 8)
- [31:17](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=1877) Foley Catheter Debate and Naloxegol for Opioid-Induced Constipation (Ep 8)
- [36:17](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=2177) Respiratory Depression with PCA and the Case for Multidisciplinary Pain Teams (Ep 8)
- [41:00](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=2460) Evidence Base for Methadone and Pregabalin; Risk Factors for Persistent Pain (Ep 8)
- [46:04](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=2764) Personalized Analgesia: CYP2D6 Genotyping and Opioid Selection (Ep 8)
- [51:29](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=3089) Ongoing Research: Multi-Gene Panels, Cost-Effectiveness, and Preemptive Analgesia (Ep 8)
- [0:00](https://qa.library.globalcastmd.com/watch/criteria-for-pectus-repair-update-course-2015-997?t=0) Criteria for Pectus Repair: Polling Question (Ep 10)
- [0:00](https://qa.library.globalcastmd.com/watch/novel-index-to-estimate-the-cephalocaudal-extent-of-the-excavation-in-pectus-excavatum-jps-article-6617?t=0) Introduction of the Titanic Index for Pectus Excavatum (Ep 29)
- [0:00](https://qa.library.globalcastmd.com/watch/cost-and-outcomes-of-intercostal-nerve-cryoablation-versus-thoracic-epidural-following-the-nuss-procedure-7313?t=0) Comparison of Intercostal Nerve Cryoablation vs Thoracic Epidural for Nuss Procedure Pain Control (Ep 32)
- [0:00](https://qa.library.globalcastmd.com/watch/cryoablation-in-350-nuss-procedures-7334?t=0) Cryoanalgesia Experience Curve in Nuss Procedures (Ep 33)
- [0:00](https://qa.library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=0) Cryoablation in Slipping Rib Syndrome Surgery (Ep 35)
- [0:00](https://qa.library.globalcastmd.com/watch/impact-of-cryoanalgesia-use-during-minimally-invasive-pectus-excavatum-repair-on-hospital-days-and-total-hospital-costs-among-pediatric-patients-7862?t=0) Cryoanalgesia in Pectus Excavatum Repair: Study Overview (Ep 38)
- [0:00](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=0) Introduction and Overview of Physiologic Testing in Pectus (Ep 4)
- [2:43](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=163) Echocardiographic Findings and Cardiac Output Improvements (Ep 4)
- [6:10](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=370) Cardiopulmonary Exercise Testing Protocol and Results (Ep 4)
- [8:30](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=510) Cardiologist Perspective on Exercise Testing (Ep 4)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Common presenting symptoms of pectus excavatum are easy fatigability with exertion, shortness of breath with exertion, and chest pain in the area of the pectus depression, generally occurring with exertion rather than at rest." — Robert Kelly (clinical) [Ep 20 · 1:33](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=93)
- "Both Marfan syndrome and Ehlers-Danlos syndrome are conditions for which pectus excavatum is a marker." — Robert Kelly (clinical) [Ep 20 · 2:55](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=175)
- "In patients with normal chest anatomy, ribs should move like the handle of a bucket (up and out) and the sternum should move like the handle of an old-fashioned water pump (towards the ceiling and out towards the examiner) during respiration." — Robert Kelly (clinical) [Ep 20 · 4:04](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=244)
- "In pectus excavatum, the depressed area of the chest is frequently absolutely fixed or in younger patients may move paradoxically, with the xiphoid pulling back towards the spine when the patient takes a deep breath." — Robert Kelly (clinical) [Ep 20 · 4:29](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=269)
- "In a series of more than 4000 patients evaluated for pectus excavatum, just over 25% had scoliosis." — Robert Kelly (epidemiological) [Ep 20 · 6:15](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=375)
- "When both severe scoliosis (past 40 or 50 degrees requiring spinal procedure) and pectus excavatum are present, the more clinically disruptive problem should be addressed first, in consultation with the orthopedic surgeon." — Robert Kelly (clinical) [Ep 20 · 6:36](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=396)
- "In the multi-center study of pectus excavatum involving 11 centers, roughly two-thirds of patients had symptoms of easy fatigability, shortness of breath with exertion, or chest pain." — Robert Kelly (epidemiological) [Ep 20 · 8:39](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=519)
- "The Haller index is the ratio of the inner transverse diameter divided by the distance between the back of the sternum and the front of the spine. Haller reported in 1987 that an index greater than 3.25 indicates severe pectus." — Robert Kelly (clinical) [Ep 20 · 9:44](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=584)
- "The Kansas City group recognized that in patients with a barrel chest, the Haller index underestimates the depth of depression because the AP diameter is increased. They advocate an alternative index comparing the depth at the depression to the depth more laterally, with more than 10% drop considered significant." — Robert Kelly (host_summary) [Ep 20 · 10:09](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=609)
- "Mitral valve prolapse is present in about 14% of pectus excavatum patients in Dr. Kelly's series, compared to about 1% in young patients in the general population." — Robert Kelly (epidemiological) [Ep 20 · 12:53](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=773)
- "On average in a large number of pectus excavatum patients, pulmonary function tests are down by about one standard deviation from average (somewhere between 85 and 90% predicted)." — Robert Kelly (epidemiological) [Ep 20 · 13:37](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=817)
- "In both Dr. Kelly's series and the multi-center study, patients came up by close to a standard deviation in pulmonary function when they had the bellows action of the chest restored by surgery." — Robert Kelly (clinical) [Ep 20 · 14:15](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=855)
- "Restrictive lung disease (FVC less than 80% predicted with normal FEV1/FVC ratio) is present in a significant fraction of pectus excavatum patients and is corrected by pectus operation, unlike asthma which is not corrected." — Robert Kelly (clinical) [Ep 20 · 14:37](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=877)
- "Patients with worse pectus excavatum have more likelihood of having restrictive pulmonary problems." — Robert Kelly (clinical) [Ep 20 · 15:05](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=905)
- "Dr. Kelly's indications for pectus excavatum operation require at least 3 of 6 criteria: Haller index >3.2, pulmonary function tests decreased below 80% predicted, cardiac compression/mitral valve prolapse/other echo abnormalities, symptoms, progressive pectus, or major psychosocial issues related to body image." — Robert Kelly (guideline) [Ep 20 · 15:11](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=911)
- "Around the time of the teenage growth spurt, there are many children in whom the pectus gets significantly deeper, and progressive deepening is considered a reason to intervene before it becomes more difficult to correct." — Robert Kelly (clinical) [Ep 20 · 15:35](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=935)
- "The ideal age for pectus excavatum surgery is sometime just prior to the onset of puberty or early in puberty: in girls age 11 to 13, and in boys a year or two older than that." — Robert Kelly (clinical) [Ep 20 · 16:47](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1007)
- "Having the bar in place during the rapid growth spurt of puberty results in extremely low likelihood of recurrence if the bar remains until that process is completed or nearly completed." — Robert Kelly (clinical) [Ep 20 · 17:02](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1022)
- "Some Asian groups, particularly Dr. Park in Korea, operate on pectus excavatum patients when they are quite young (well under 10 years old) and report good results." — Robert Kelly (host_summary) [Ep 20 · 17:29](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1049)
- "Dr. Kelly's center uses patient-controlled analgesia (PCA) pumps with a steady background dose of narcotic and ability to give booster doses, emphasizing the need to dial in the correct dose on the night of surgery based on patient feedback." — Robert Kelly (clinical) [Ep 20 · 18:49](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1129)
- "Dr. Kelly's center has not used epidurals for pectus excavatum surgery for several years." — Robert Kelly (clinical) [Ep 20 · 19:39](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1179)
- "Postoperative recommendations include spirometry hourly when awake, walking beginning the day after operation (emphasizing frequency over distance), eating small amounts (a couple hundred calories) every couple hours if appetite is reduced, and not rushing recovery." — Robert Kelly (clinical) [Ep 20 · 19:47](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1187)
- "For the first month after pectus excavatum surgery, patients should only walk and perform activities of daily living. Beginning at 1 month they can liberalize physical activities, and by 3 to 6 months can do almost any activity except those where they know they will get a blow to the chest." — Robert Kelly (clinical) [Ep 20 · 20:46](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1246)
- "The Allergies test developed in Canada includes all components of the stainless steel bar and is used for preoperative metal allergy screening. Patients who react (most commonly to nickel, but also chromium, cobalt, and other components) can receive a titanium bar, which must be bent at the factory and ordered in advance." — Robert Kelly (clinical) [Ep 20 · 21:37](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1297)
- "Titanium bars are currently much more expensive than stainless steel bars. In an era of responsible cost containment, if stainless steel works well and costs less, it should be used when appropriate." — Robert Kelly (opinion) [Ep 20 · 22:17](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1337)
- "For Nuss procedure, thoracoscopy should be standard practice in patients with any difficulty in visualization, to ensure the tip of the introducer is seen at all times when passing from one side to the other." — Robert Kelly (guideline) [Ep 20 · 24:43](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1483)
- "Sternal elevation techniques (vacuum bell, subxiphoid finger or bone hook, or Rultract device) are really important for Nuss procedure to improve visualization and make the path from one side to the other easier to identify." — Robert Kelly (clinical) [Ep 20 · 24:57](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1497)
- "The most important part of the Nuss procedure is seeing the tip of the introducer at all times when passing from one side to the other. If this is done, the likelihood of injuring the heart is exceedingly low." — Robert Kelly (clinical) [Ep 20 · 26:02](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1562)
- "To prevent bar displacement in Nuss procedure, Dr. Kelly favors using a tongue-in-groove stabilizer on one end of the bar and wrapping around the bar and adjacent rib with heavy absorbable suture (number 1 PDS), commonly putting 4 thicknesses around the intersection of bar and rib." — Robert Kelly (clinical) [Ep 20 · 26:43](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1603)
- "For Nuss procedure incisions, measure from mid-axillary line to mid-axillary line and subtract an inch to determine bar length. Make 2-3 cm incisions more or less from anterior to mid-axillary line at the cephalocaudad level of the deepest point of the pectus." — Robert Kelly (clinical) [Ep 20 · 27:32](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1652)
- "In post-pubertal girls, making an incision where the breast meets the chest wall in a curved incision along the line of the breast gives excellent access and is a little more medial than the standard incision, which can be more convenient." — Robert Kelly (clinical) [Ep 20 · 27:39](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1659)
- "The bar should rest medial to the pectus ridge so there is a rib providing counterforce anteriorly on each side while the sternum pushes posteriorly. If placed very laterally, only intercostal muscles prevent movement and they will strip or rip under the load." — Robert Kelly (clinical) [Ep 20 · 28:54](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1734)
- "In growing patients, stabilizers on both sides of the bar can cause a wasp-waist effect when encased by scar, so Dr. Kelly generally favors putting stabilizers on only one side of the bar." — Robert Kelly (clinical) [Ep 20 · 30:07](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1807)
- "Patients over approximately 6 feet 2 inches tall have almost 100% chance of needing two bars for Nuss procedure. For shorter patients, the decision depends on how the sternum came up at operation." — Robert Kelly (clinical) [Ep 20 · 30:39](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1839)
- "The Chestwall International Group will be meeting June 15-17, 2016 in Norfolk, Virginia with participants from around the world presenting on various aspects of chest wall deformities." — Robert Kelly (clinical) [Ep 20 · 31:17](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1877)
- "Postoperatively for Nuss procedure, Dr. Kelly's center tries to wean patients off the PCA pump by stopping the basal rate on the second day and stopping the PCA altogether on the third day, so by the third day patients are on all oral medicines." — Robert Kelly (clinical) [Ep 20 · 32:02](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1922)
- "In multiple series of Nuss procedures, short-term complications are few and intervention has been infrequent." — Robert Kelly (host_summary) [Ep 20 · 33:03](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1983)
- "In Dr. Kelly's series of past 2000 Nuss procedures, about 2.7% of patients have required some sort of revision for bar displacement. This incidence has been cut to about half by using stabilizers and wrapping around the crossing of the bar to the rib with pericostal sutures." — Robert Kelly (epidemiological) [Ep 20 · 33:14](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1994)
- "Most bar displacement in Dr. Kelly's current experience involves some kind of marked force, such as trauma from accidents." — Robert Kelly (clinical) [Ep 20 · 33:43](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2023)
- "Bar allergy occurred in a little less than 1% (0.9%) of patients. Since screening for metal allergy began in 2004, this has dramatically decreased the incidence. About 6.4% of patients had clinical or patch test evidence of metal allergy." — Robert Kelly (epidemiological) [Ep 20 · 34:13](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2053)
- "Wound infection occurred in 2.3% of patients in Dr. Kelly's series, with more than two-thirds being superficial or cellulitis. The center emphasizes skin preparation and perioperative antibiotics using an infection prevention bundle." — Robert Kelly (epidemiological) [Ep 20 · 34:40](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2080)
- "Recurrence after Nuss procedure occurred in about 1.2% of patients in Dr. Kelly's series. Why recurrence happens is still poorly understood, even when bars are left in for 3 years." — Robert Kelly (epidemiological) [Ep 20 · 35:07](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2107)
- "Dr. Kelly's center tries to see patients at 6 months after operation and then organize when bar removal will be. They favor removing the bar closer to 3 years than to 2 years, but it needs to be at least 2 years before removal." — Robert Kelly (clinical) [Ep 20 · 36:33](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2193)
- "The vacuum bell treatment for pectus excavatum was developed by Kloby in Germany. A recent paper from a hospital in Saint-Etienne, France published in Journal of Pediatric Surgery found it effective in eliminating pectus excavatum in 23 of 73 patients." — Robert Kelly (host_summary) [Ep 20 · 37:19](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2239)
- "Dr. Kelly's center has been using the vacuum bell for about 2 years and believes that in patients who are young (under about 10 years old), the vacuum bell can be very effective in lifting the chest up." — Robert Kelly (clinical) [Ep 20 · 37:49](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2269)
- "In patients with recurrent pectus excavatum following a previous Ravitch operation, a Nuss procedure can elevate the chest to some extent but won't restore chest wall movement, and patients will have some restrictive process from scarring. In some of these patients, a Ravitch operation may be beneficial." — Robert Kelly (clinical) [Ep 20 · 39:06](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2346)
- "Because brace therapy for pectus carinatum has been demonstrated to be successful in many places (somewhere between two-thirds and three-quarters of patients are cured), and any operation carries more morbidity than almost any brace, it is hard to justify not starting with brace treatment for most patients." — Robert Kelly (opinion) [Ep 20 · 40:04](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2404)
- "Dr. Kelly's center generally uses Marcello Ferro's dynamic compression system for pectus carinatum. The brace solved two patient objections: it is comfortable (pressure can be adjusted) and concealable (not visible under an opaque t-shirt). It works approximately three-quarters of the time in their hands." — Robert Kelly (clinical) [Ep 20 · 41:23](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2483)
- "Candidates for surgical treatment of pectus carinatum include patients who fail brace therapy, those with significant symptoms (pain and exercise limitation, though most carinatum patients do not have symptoms), and those whose chest is very stiff and not making progress with bracing." — Robert Kelly (clinical) [Ep 20 · 42:35](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2555)
- "The reverse Nuss operation (Abramson procedure) for pectus carinatum involves placing a bar in front of the sternum to pull it back. Dr. Kelly's center has used this operation since 2008 and it works well in patients with a flexible chest." — Robert Kelly (clinical) [Ep 20 · 43:13](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2593)
- "There is a broad perception among surgeons who have done many Ravitch operations for carinatum that there is an extremely low recurrence rate after that procedure, as opposed to the 10% recurrence rate after excavatum Ravitch." — Robert Kelly (host_summary) [Ep 20 · 43:43](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2623)
- "There is a family tendency for chest wall deformities in approximately 40% of patients, but the majority still don't have a family history." — Robert Kelly (epidemiological) [Ep 20 · 44:52](https://qa.library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2692)
- "Repair of pectus excavatum using minimally invasive techniques with intercostal nerve cryoablation decreases patient length of stay and opioid use" — Kim Priven (clinical) [Ep 43 · 0:00](https://qa.library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729?t=0)
- "This was a single institution prospective cohort study of 47 patients under 21 years of age" — Kim Priven (clinical) [Ep 43 · 0:19](https://qa.library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729?t=19)
- "Patients presented for bar removal after a median of two bars were placed for 2.9 years" — Kim Priven (clinical) [Ep 43 · 0:19](https://qa.library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729?t=19)
- "The study assessed patients for chest wall hypoesthesia to cold, soft touch, and pinprick, as well as neuropathic pain" — Kim Priven (clinical) [Ep 43 · 0:35](https://qa.library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729?t=35)
- "46.8% of patients had identifiable chest wall hypoesthesia" — Kim Priven (clinical) [Ep 43 · 0:46](https://qa.library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729?t=46)
- "9.3% of patients had hypoesthesia to cold response" — Kim Priven (clinical) [Ep 43 · 0:46](https://qa.library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729?t=46)
- "7.7% of patients had hypoesthesia to soft touch" — Kim Priven (clinical) [Ep 43 · 0:46](https://qa.library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729?t=46)
- "11.8% of patients had hypoesthesia to pinprick" — Kim Priven (clinical) [Ep 43 · 0:46](https://qa.library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729?t=46)
- "Neuropathic pain symptoms were identified in 13% of patients" — Kim Priven (clinical) [Ep 43 · 0:58](https://qa.library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729?t=58)
- "None of the patients with neuropathic pain symptoms required treatment" — Kim Priven (clinical) [Ep 43 · 0:58](https://qa.library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729?t=58)
- "Pediatric patients who underwent minimally invasive repair with cryoablation will often develop some small areas of hypoesthesia" — Kim Priven (clinical) [Ep 43 · 1:04](https://qa.library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729?t=64)
- "Clinically significant neuropathic pain is rare after minimally invasive pectus excavatum repair with cryoablation" — Kim Priven (clinical) [Ep 43 · 1:04](https://qa.library.globalcastmd.com/watch/long-term-sensory-function-3-years-after-minimally-invasive-repair-of-pectus-excavatum-with-cryoablation-8729?t=64)
- "The study was an observational perspective study conducted in Italy from 2013 to 2022." — Lizzie Lee (epidemiological) [Ep 45 · 0:13](https://qa.library.globalcastmd.com/watch/pectus-bar-dislocation-comparison-between-three-different-stabilization-techniques-adopted-in-a-single-centre-9184?t=13)
- "The study included 468 patients around 15 years old." — Lizzie Lee (epidemiological) [Ep 45 · 0:13](https://qa.library.globalcastmd.com/watch/pectus-bar-dislocation-comparison-between-three-different-stabilization-techniques-adopted-in-a-single-centre-9184?t=13)
- "Surgeons placed 733 bars total across the patient cohort." — Lizzie Lee (epidemiological) [Ep 45 · 0:23](https://qa.library.globalcastmd.com/watch/pectus-bar-dislocation-comparison-between-three-different-stabilization-techniques-adopted-in-a-single-centre-9184?t=23)
- "Bar dislocation is defined as when a bar rotates more than 30 degrees out of place." — Lizzie Lee (clinical) [Ep 45 · 0:31](https://qa.library.globalcastmd.com/watch/pectus-bar-dislocation-comparison-between-three-different-stabilization-techniques-adopted-in-a-single-centre-9184?t=31)
- "Bridge fixation was significantly more stable than single bar fixation." (clinical) [Ep 45 · 0:38](https://qa.library.globalcastmd.com/watch/pectus-bar-dislocation-comparison-between-three-different-stabilization-techniques-adopted-in-a-single-centre-9184?t=38)
- "None of the patients with bridge fixation had dislocated bars." — Lizzie Lee (clinical) [Ep 45 · 0:43](https://qa.library.globalcastmd.com/watch/pectus-bar-dislocation-comparison-between-three-different-stabilization-techniques-adopted-in-a-single-centre-9184?t=43)
- "Bridge fixation is the best technique for preventing bar dislocation in pectus excavatum patients." (opinion) [Ep 45 · 0:49](https://qa.library.globalcastmd.com/watch/pectus-bar-dislocation-comparison-between-three-different-stabilization-techniques-adopted-in-a-single-centre-9184?t=49)
- "Cincinnati Children's is the only pediatric hospital with an inpatient integrative care team consisting of about 15 holistic health specialists." (clinical) [Ep 6 · 0:04](https://qa.library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=4)
- "Massage therapy can reduce pain and anxiety, decrease cortisol levels, and enhance relaxation in pectus repair patients." (clinical) [Ep 6 · 0:55](https://qa.library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=55)
- "Energy therapies (Reiki and healing touch) are biofield therapies that work to restore harmony and balance within the body and can be performed hands-on or hands-off." (clinical) [Ep 6 · 1:31](https://qa.library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=91)
- "A 2009 retrospective database review of 519 patients showed that massage therapy and healing touch reduced pain and anxiety scores by 50% in 50% of patients." (clinical) [Ep 6 · 3:01](https://qa.library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=181)
- "Early mobility after pectus repair helps reduce the rate of complications and decrease overall length of stay." (host_summary) [Ep 6 · 5:44](https://qa.library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=344)
- "Physical therapy evaluates pectus patients on the first postoperative day and teaches them to get out of bed using a crunch-to-sit-up technique without using arms to push or pull." (clinical) [Ep 6 · 5:54](https://qa.library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=354)
- "Pectus repair patients have strict precautions against bending, twisting, and rolling postoperatively." (clinical) [Ep 6 · 6:23](https://qa.library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=383)
- "All pectus patients and families are required to attend a preoperative education class before scheduled surgery." (clinical) [Ep 6 · 9:24](https://qa.library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=564)
- "The preoperative class covers expectations for testing, hospital stay, recovery room experience, epidural placement, and postoperative devices including compression boots, Foley catheter, and incentive spirometer." (clinical) [Ep 6 · 9:30](https://qa.library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=570)
- "The SSI (surgical site infection) bundle for pectus patients includes screening all patients for metal allergy, MRSA, and staph, with treatment using Bactroban if positive." (clinical) [Ep 6 · 11:27](https://qa.library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=687)
- "The SSI bundle has been in place for almost 3 years and was developed through literature review and collaboration with infectious disease." (clinical) [Ep 6 · 11:27](https://qa.library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=687)
- "70% of adult patients with Ehlers-Danlos syndrome experience blacking out sensation or dizziness with standing associated with racing heartbeat (POTS)." (epidemiological) [Ep 6 · 14:49](https://qa.library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=889)
- "Most pain in Ehlers-Danlos patients is muscle-based or from muscle attachments rather than arthritis or bone pain." (clinical) [Ep 6 · 13:53](https://qa.library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=833)
- "Ehlers-Danlos patients have impaired proprioception with more movement than they should, demonstrated in multiple studies and meta-analyses, due to connective tissue dysfunction in feedback structures." (host_summary) [Ep 6 · 14:21](https://qa.library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=861)
- "Ehlers-Danlos patients with POTS phenotype have overactivity of the sympathetic nervous system, leading to panic, anxiety, sleep dysfunction, and chronic fatigue." (clinical) [Ep 6 · 15:38](https://qa.library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=938)
- "Sympathetic nervous system overactivity in Ehlers-Danlos patients shuts down parasympathetic digestive functions, causing nausea or abdominal pain immediately after eating." (clinical) [Ep 6 · 16:06](https://qa.library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=966)
- "The Dallas protocol for dysautonomia treatment requires 5 days per week, 30 minutes per day of exercise reaching 80% of maximum heart rate." (host_summary) [Ep 6 · 17:39](https://qa.library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=1059)
- "Ehlers-Danlos patients with POTS should use recumbent exercise (bike or rowing machine) or aquatic-based therapy rather than upright exercise like treadmills, which cause immediate dizziness and tachycardia." (clinical) [Ep 6 · 18:06](https://qa.library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=1086)
- "Aquatic-based therapy supports blood flow to the brain in Ehlers-Danlos patients with dysautonomia." (clinical) [Ep 6 · 18:33](https://qa.library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=1113)
- "Recumbent or aquatic exercise protocols in Ehlers-Danlos patients have shown improvements in chronic fatigue, sleep dysfunction, and pain sensitivity." (clinical) [Ep 6 · 18:43](https://qa.library.globalcastmd.com/watch/pectus-patient-and-family-education-690?t=1123)
- "Nothing is as good as epidural analgesia for pectus patients; On-Q pumps come second to epidural in Cincinnati's experience." — Centel Sadai (opinion) [Ep 8 · 0:29](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=29)
- "Seattle Children's Hospital, which transitioned from epidural to On-Q pumps, is experiencing issues with pain management." — Centel Sadai (host_summary) [Ep 8 · 0:45](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=45)
- "More than 95% of Cincinnati's pectus patients do not receive PCA along with epidural." — Centel Sadai (clinical) [Ep 8 · 1:28](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=88)
- "The pain team sees pectus patients at least 3 times per day and tweaks epidural rate or position to optimize analgesia." — Centel Sadai (clinical) [Ep 8 · 1:38](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=98)
- "More than 99% of Cincinnati's pectus patients receive epidural analgesia." — Centel Sadai (clinical) [Ep 8 · 2:04](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=124)
- "Older patients and young adults have more pain after pectus repair due to chest wall rigidity." — Centel Sadai (clinical) [Ep 8 · 2:24](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=144)
- "Patients with Ehlers-Danlos syndrome have extensive pain and may have pain even before surgery." — Centel Sadai (clinical) [Ep 8 · 2:35](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=155)
- "Patients with psychological problems like depression and excessive anxiety benefit from On-Q pumps in addition to epidural." — Centel Sadai (clinical) [Ep 8 · 2:49](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=169)
- "Patients with family history of substance abuse benefit from minimizing opioid use through epidural and On-Q pump." — Centel Sadai (clinical) [Ep 8 · 2:58](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=178)
- "Pain catastrophization (anticipating negative outcomes) in children or parents is associated with more postoperative pain." — Centel Sadai (clinical) [Ep 8 · 3:29](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=209)
- "Two major risks with epidural are injury during placement (including paraplegia) and infection (epidural abscess) if the catheter is left too long." — Centel Sadai (clinical) [Ep 8 · 4:25](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=265)
- "Cincinnati places epidurals in awake patients with minimal sedation in sitting position to minimize risk of traumatic placement." — Centel Sadai (clinical) [Ep 8 · 4:50](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=290)
- "Cincinnati removes epidural catheters on the 3rd day after surgery to prevent epidural abscess." — Centel Sadai (clinical) [Ep 8 · 5:24](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=324)
- "Most neurological injury from epidural in children is from hypoperfusion of the spinal cord, not traumatic placement." — Centel Sadai (clinical) [Ep 8 · 5:30](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=330)
- "Cincinnati aggressively manages blood pressure to maintain spinal cord perfusion, reducing epidural rate and removing clonidine if blood pressure is low." — Centel Sadai (clinical) [Ep 8 · 5:49](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=349)
- "On-Q pump effectiveness depends on multiple factors: delivery amount, delivery location, catheter size and length, and introducer size relative to track." — Don (clinical) [Ep 8 · 7:59](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=479)
- "Most On-Q data in thoracic surgery is from thoracotomy with subpleural tunneling, making it difficult to extrapolate to pectus repair." — Don (clinical) [Ep 8 · 8:25](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=505)
- "The 5 cm On-Q catheter is too short to cover the pectus repair area; the 7.5 cm catheter is much better." — Don (clinical) [Ep 8 · 8:10](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=490)
- "Exparel (liposomal bupivacaine) is safer than plain local anesthetic because the treatment for local anesthetic toxicity is intralipid, which Exparel already contains." — Centel Sadai (clinical) [Ep 8 · 10:32](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=632)
- "In Cincinnati's donor nephrectomy experience with Exparel TAP blocks, patients discontinue PCA one day earlier and use fewer opioids with fewer side effects." — Centel Sadai (clinical) [Ep 8 · 10:49](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=649)
- "Exparel is not FDA-approved for pediatric use." — Centel Sadai (guideline) [Ep 8 · 11:01](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=661)
- "Some patients have localized reactions to Exparel severe enough to require steroids, with reactions lasting 3 days." — Don (clinical) [Ep 8 · 11:23](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=683)
- "Cincinnati allows patients with epidurals to walk inside the room and even outside with help because there are no narcotics in the epidural solution." — Centel Sadai (clinical) [Ep 8 · 12:05](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=725)
- "Cincinnati removes Foley catheters the day after surgery and allows ambulation, which epidural facilitates." — Centel Sadai (clinical) [Ep 8 · 12:17](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=737)
- "Cincinnati's preoperative preparation includes mandatory pain education by a pain nurse 2-3 months before surgery and optional genetic research for opioid risk." — Centel Sadai (clinical) [Ep 8 · 14:36](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=876)
- "Medical literature shows meditation benefits include minimizing pain, anxiety, and improving immune function after surgery." — Centel Sadai (host_summary) [Ep 8 · 15:58](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=958)
- "Opioids have a narrow therapeutic index: beyond a certain dose they will not relieve pain but can cause significant side effects." — Centel Sadai (clinical) [Ep 8 · 18:35](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=1115)
- "About 20-30% of pectus patients experience chronic persistent post-operative pain, defined as pain score of 3 or more two months after surgery." — Centel Sadai (epidemiological) [Ep 8 · 18:00](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=1080)
- "If a child is on 5 consecutive days of oxycodone or any other opioid, the risk of dependence increases significantly." — Centel Sadai (clinical) [Ep 8 · 19:50](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=1190)
- "Strong adult literature shows that regional analgesia (epidural or On-Q pump) reduces persistent post-operative pain, including after thoracotomy." — Centel Sadai (host_summary) [Ep 8 · 19:24](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=1164)
- "A 2023 meta-analysis of 6 studies comparing epidural to PCA for pectus repair found epidural provided better pain control in the first 2 days." — Centel Sadai (host_summary) [Ep 8 · 21:42](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=1302)
- "Two studies from Kansas had epidural failure rates of 22% and 35%, likely explaining why epidural didn't provide superior pain relief in those studies." — Centel Sadai (host_summary) [Ep 8 · 22:19](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=1339)
- "Cincinnati's epidural success rate is more than 95%, with less than 5% of patients needing PCA on top of epidural (down from 14% in 2013)." — Centel Sadai (clinical) [Ep 8 · 25:02](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=1502)
- "With good epidural function, Cincinnati achieves zero pain scores immediately after pectus surgery in the first 2-3 days, which was unheard of 10-15 years ago." — Centel Sadai (clinical) [Ep 8 · 23:28](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=1408)
- "Cincinnati uses local anesthetic-only epidural solution (no opioids), which does not cause urinary retention and is very dermatomal, blocking only thoracic dermatomes." — Centel Sadai (clinical) [Ep 8 · 23:58](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=1438)
- "Most Cincinnati pectus patients are discharged on the 3rd or 4th day after surgery." — Centel Sadai (clinical) [Ep 8 · 24:18](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=1458)
- "Cincinnati uses pregabalin preoperatively; literature shows that giving pregabalin or gabapentin one hour before surgery significantly decreases postoperative pain and opioid need." — Centel Sadai (clinical) [Ep 8 · 25:45](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=1545)
- "Cincinnati uses IV methadone intraoperatively and for the first 2 days; literature shows even one intraoperative dose significantly decreases pain and opioid use for 2 days." — Centel Sadai (clinical) [Ep 8 · 25:31](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=1531)
- "Cincinnati reduced methadone dose from 15-20 mg (adult dose) to 5 mg maximum in teenagers due to excessive sedation with higher doses combined with pregabalin and anesthesia." — Centel Sadai (clinical) [Ep 8 · 27:15](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=1635)
- "Cincinnati uses IV methocarbamol routinely for muscle spasms after pectus surgery, which reduces the need for IV diazepam." — Centel Sadai (clinical) [Ep 8 · 27:42](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=1662)
- "Methadone can cause QT interval prolongation; Cincinnati performs baseline EKG preoperatively and post-op day 1 EKG to ensure QT doesn't exceed 480 milliseconds." — Centel Sadai (clinical) [Ep 8 · 28:19](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=1699)
- "Cincinnati alternates IV ketorolac every 6 hours with IV acetaminophen to minimize opioid use." — Centel Sadai (clinical) [Ep 8 · 28:36](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=1716)
- "Less than 5% of Cincinnati's pectus patients need any IV opioid in the first 2-3 days when they have epidural." — Centel Sadai (clinical) [Ep 8 · 28:47](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=1727)
- "Cincinnati delays starting oxycodone until post-op day 2 when possible to minimize opioid exposure." — Centel Sadai (clinical) [Ep 8 · 29:10](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=1750)
- "Cincinnati stops epidural abruptly at 6 AM on post-op day 3 without weaning." — Centel Sadai (clinical) [Ep 8 · 31:27](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=1887)
- "For selected high-risk patients, Cincinnati places subcutaneous intercostal On-Q catheters, starting at 1 mL/hour per side with epidural, then increasing to 4-6 mL/hour per side after epidural removal." — Centel Sadai (clinical) [Ep 8 · 30:10](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=1810)
- "The advantage of not using opioids in epidural solution is minimal; opioids cause more problems (itching, urinary retention) than benefits. Clonidine provides the same pain relief benefits without these side effects." — Centel Sadai (clinical) [Ep 8 · 32:02](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=1922)
- "Cincinnati uses high concentration ropivacaine (0.2%) in epidural solution for good pain control; lower concentrations (0.12% or 0.15%) don't provide adequate pain relief." — Centel Sadai (clinical) [Ep 8 · 32:22](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=1942)
- "Mark Saxton's data shows 1 in 7 patients (approximately 14%) require catheterization for urinary retention when Foley catheters are not routinely placed." (host_summary) [Ep 8 · 34:11](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=2051)
- "About 50% of patients on oxycodone develop opioid-induced constipation." — Centel Sadai (clinical) [Ep 8 · 35:14](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=2114)
- "Naloxegol is similar to naloxone but doesn't cross the blood-brain barrier, so it relieves opioid-induced constipation without reversing analgesia." — Centel Sadai (clinical) [Ep 8 · 35:22](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=2122)
- "Naloxegol is FDA-approved for opioid-induced constipation but not yet approved for pediatric use; Cincinnati uses it off-label." — Centel Sadai (clinical) [Ep 8 · 35:25](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=2125)
- "In spine surgery patients receiving PCA (without epidural), about 15% experience respiratory depression defined as respiratory rate less than 8 breaths per minute and oxygen saturation less than 90%." — Centel Sadai (clinical) [Ep 8 · 36:52](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=2212)
- "Tramadol is similar to codeine; about 80-85% of the population are intermediate or extensive metabolizers with good pain control, 10-12% are poor metabolizers with inadequate pain relief, and 1-2% are ultra-rapid metabolizers at risk for respiratory depression and death." — Centel Sadai (clinical) [Ep 8 · 37:49](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=2269)
- "In Ethiopian populations, ultra-rapid metabolizers can be as high as 29%, compared to 1-2% in Cincinnati's population." — Centel Sadai (epidemiological) [Ep 8 · 49:45](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=2985)
- "The FDA has warned against use of codeine following tonsillectomy; warnings for tramadol and hydrocodone are under FDA review." — Centel Sadai (guideline) [Ep 8 · 50:00](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=3000)
- "Among currently available opioids, oxycodone is the least affected by CYP2D6 metabolism." — Centel Sadai (clinical) [Ep 8 · 50:13](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=3013)
- "Cincinnati avoids oxycodone in ultra-rapid metabolizers and uses oral hydromorphone (Dilaudid) instead." — Centel Sadai (clinical) [Ep 8 · 50:29](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=3029)
- "Even extensive metabolizers (normal population) with comorbidities like asthma or sleep apnea are at high risk for sedation and respiratory depression, so Cincinnati reduces oxycodone doses in these patients." — Centel Sadai (clinical) [Ep 8 · 51:01](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=3061)
- "Sedation always precedes respiratory depression; Cincinnati nurses monitor sedation using Ramsay sedation scale every shift to prevent respiratory depression." — Centel Sadai (clinical) [Ep 8 · 51:29](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=3089)
- "Cincinnati monitors end-tidal carbon dioxide continuously for the first 24 hours after pectus surgery." — Centel Sadai (clinical) [Ep 8 · 51:44](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=3104)
- "Cincinnati has not used naloxone for any pain patients in more than 3 years." — Centel Sadai (clinical) [Ep 8 · 52:02](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=3122)
- "Cincinnati's 50-gene panel costs $50 (less than $1 per gene) and is covered by most insurance companies." — Centel Sadai (clinical) [Ep 8 · 52:23](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=3143)
- "Cost-benefit analysis for one gene (fatty acid amide hydrolase) associated with nausea, vomiting, and prolonged PACU stay shows savings of more than $100 per patient when genotype-guided dosing is used." — Centel Sadai (clinical) [Ep 8 · 52:42](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=3162)
- "Intercostal blocks are better than nothing for preemptive analgesia but may miss one or two intercostal nerves, making them less effective than epidural." — Centel Sadai (clinical) [Ep 8 · 53:24](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=3204)
- "Cincinnati places all epidurals before surgical incision using high-concentration local anesthetic (0.2% ropivacaine) for optimal preemptive analgesia, balancing efficacy against hypotension risk." — Centel Sadai (clinical) [Ep 8 · 53:44](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pain-management-at-cincinnati-children-s-hospital-693?t=3224)
- "The Haller index and correction index are the currently primarily used indices for pectus excavatum and tell us about the severity of the deformity." — Ellen Encisco (clinical) [Ep 29 · 0:11](https://qa.library.globalcastmd.com/watch/novel-index-to-estimate-the-cephalocaudal-extent-of-the-excavation-in-pectus-excavatum-jps-article-6617?t=11)
- "The Titanic index takes into account the extent of the pectus excavatum deformity." — Ellen Encisco (clinical) [Ep 29 · 0:19](https://qa.library.globalcastmd.com/watch/novel-index-to-estimate-the-cephalocaudal-extent-of-the-excavation-in-pectus-excavatum-jps-article-6617?t=19)
- "The Titanic index is calculated as the percentage of the sternum that lies behind the anterior costal line as seen on CT scans." — Ellen Encisco (clinical) [Ep 29 · 0:25](https://qa.library.globalcastmd.com/watch/novel-index-to-estimate-the-cephalocaudal-extent-of-the-excavation-in-pectus-excavatum-jps-article-6617?t=25)
- "The study was a retrospective review of patients at an institution in Argentina who had undergone minimally invasive repair of pectus excavatum." — Ellen Encisco (clinical) [Ep 29 · 0:35](https://qa.library.globalcastmd.com/watch/novel-index-to-estimate-the-cephalocaudal-extent-of-the-excavation-in-pectus-excavatum-jps-article-6617?t=35)
- "The study found a weak correlation between the Titanic index and the other indices (Haller and correction index)." — Ellen Encisco (clinical) [Ep 29 · 0:46](https://qa.library.globalcastmd.com/watch/novel-index-to-estimate-the-cephalocaudal-extent-of-the-excavation-in-pectus-excavatum-jps-article-6617?t=46)
- "The Titanic index might be more helpful for helping determine how many bars a patient is going to need for repair." — Ellen Encisco (clinical) [Ep 29 · 0:46](https://qa.library.globalcastmd.com/watch/novel-index-to-estimate-the-cephalocaudal-extent-of-the-excavation-in-pectus-excavatum-jps-article-6617?t=46)
- "The threshold established was 66.5%, meaning that patients with a higher Titanic index than that probably needed more than 2 bars." — Ellen Encisco (clinical) [Ep 29 · 0:57](https://qa.library.globalcastmd.com/watch/novel-index-to-estimate-the-cephalocaudal-extent-of-the-excavation-in-pectus-excavatum-jps-article-6617?t=57)
- "More study is needed for this index." — Ellen Encisco (opinion) [Ep 29 · 1:06](https://qa.library.globalcastmd.com/watch/novel-index-to-estimate-the-cephalocaudal-extent-of-the-excavation-in-pectus-excavatum-jps-article-6617?t=66)
- "Thoracic epidural and intercostal nerve cryoablation are two options for pain control in patients undergoing a Nuss procedure for pectus excavatum" — Alex Halpern (clinical) [Ep 32 · 0:00](https://qa.library.globalcastmd.com/watch/cost-and-outcomes-of-intercostal-nerve-cryoablation-versus-thoracic-epidural-following-the-nuss-procedure-7313?t=0)
- "Dr. Tsai and his team from Penn State conducted a retrospective chart review looking at kids who underwent a Nuss procedure between 2002 and 2020" — Alex Halpern (clinical) [Ep 32 · 0:19](https://qa.library.globalcastmd.com/watch/cost-and-outcomes-of-intercostal-nerve-cryoablation-versus-thoracic-epidural-following-the-nuss-procedure-7313?t=19)
- "The intercostal nerve cryoablation group had lower rates of PCA use compared to thoracic epidural" — Alex Halpern (clinical) [Ep 32 · 0:21](https://qa.library.globalcastmd.com/watch/cost-and-outcomes-of-intercostal-nerve-cryoablation-versus-thoracic-epidural-following-the-nuss-procedure-7313?t=21)
- "The intercostal nerve cryoablation group had lower total morphine milligram equivalent requirement compared to thoracic epidural" — Alex Halpern (clinical) [Ep 32 · 0:21](https://qa.library.globalcastmd.com/watch/cost-and-outcomes-of-intercostal-nerve-cryoablation-versus-thoracic-epidural-following-the-nuss-procedure-7313?t=21)
- "The intercostal nerve cryoablation group had shorter length of stay in the hospital compared to thoracic epidural" — Alex Halpern (clinical) [Ep 32 · 0:21](https://qa.library.globalcastmd.com/watch/cost-and-outcomes-of-intercostal-nerve-cryoablation-versus-thoracic-epidural-following-the-nuss-procedure-7313?t=21)
- "The intercostal nerve cryoablation group had longer operative times compared to thoracic epidural" — Alex Halpern (clinical) [Ep 32 · 0:44](https://qa.library.globalcastmd.com/watch/cost-and-outcomes-of-intercostal-nerve-cryoablation-versus-thoracic-epidural-following-the-nuss-procedure-7313?t=44)
- "The intercostal nerve cryoablation group had higher total hospitalization cost than the thoracic epidural group" — Alex Halpern (clinical) [Ep 32 · 0:44](https://qa.library.globalcastmd.com/watch/cost-and-outcomes-of-intercostal-nerve-cryoablation-versus-thoracic-epidural-following-the-nuss-procedure-7313?t=44)
- "Both intercostal nerve cryoablation and thoracic epidural have pros and cons for pain control following Nuss procedure" — Alex Halpern (opinion) [Ep 32 · 0:51](https://qa.library.globalcastmd.com/watch/cost-and-outcomes-of-intercostal-nerve-cryoablation-versus-thoracic-epidural-following-the-nuss-procedure-7313?t=51)
- "The study was a retrospective single institution study conducted in Phoenix from 2017 to 2021" — Cecilia Gigena (clinical) [Ep 33 · 0:10](https://qa.library.globalcastmd.com/watch/cryoablation-in-350-nuss-procedures-7334?t=10)
- "The study compared patients who underwent Nuss procedure with cryoanalgesia in the first quarter of institutional experience versus the fourth quarter" — Cecilia Gigena (clinical) [Ep 33 · 0:16](https://qa.library.globalcastmd.com/watch/cryoablation-in-350-nuss-procedures-7334?t=16)
- "350 patients underwent Nuss procedure with cryoanalgesia in the study period" — Cecilia Gigena (epidemiological) [Ep 33 · 0:29](https://qa.library.globalcastmd.com/watch/cryoablation-in-350-nuss-procedures-7334?t=29)
- "Patients in the last quarter were discharged 1.3 days earlier than patients in the first quarter" — Cecilia Gigena (clinical) [Ep 33 · 0:34](https://qa.library.globalcastmd.com/watch/cryoablation-in-350-nuss-procedures-7334?t=34)
- "Patients in the last quarter required 74% less opioids compared to the first quarter" — Cecilia Gigena (clinical) [Ep 33 · 0:34](https://qa.library.globalcastmd.com/watch/cryoablation-in-350-nuss-procedures-7334?t=34)
- "Experience plays a role in cryoanalgesia outcomes for Nuss procedures" — Cecilia Gigena (opinion) [Ep 33 · 0:46](https://qa.library.globalcastmd.com/watch/cryoablation-in-350-nuss-procedures-7334?t=46)
- "The study was a retrospective review conducted in Phoenix between 2018 and 2022" — Cecilia Gigena (clinical) [Ep 35 · 0:11](https://qa.library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=11)
- "The study compared length of stay and opiate use in patients undergoing cartilaginous rib excision with and without cryo" — Cecilia Gigena (clinical) [Ep 35 · 0:16](https://qa.library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=16)
- "The study included 98 patients total" — Cecilia Gigena (epidemiological) [Ep 35 · 0:27](https://qa.library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=27)
- "68 patients underwent resection without cryo" — Cecilia Gigena (epidemiological) [Ep 35 · 0:27](https://qa.library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=27)
- "22 patients underwent resection with cryo" — Cecilia Gigena (epidemiological) [Ep 35 · 0:27](https://qa.library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=27)
- "8 patients underwent a NAS procedure plus cartilaginous resection with cryoalgesia" — Cecilia Gigena (epidemiological) [Ep 35 · 0:27](https://qa.library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=27)
- "Patients who underwent resection with cryo had significantly less opiate use" — Cecilia Gigena (clinical) [Ep 35 · 0:43](https://qa.library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=43)
- "Patients who underwent resection with cryo stayed one day less than patients without cryo, though this difference was not statistically significant" — Cecilia Gigena (clinical) [Ep 35 · 0:43](https://qa.library.globalcastmd.com/watch/initial-outcomes-using-cryoablation-in-surgical-management-of-slipping-rib-syndrome-7456?t=43)
- "The study was a retrospective review conducted in Texas" — Cecilia Gigena (epidemiological) [Ep 38 · 0:11](https://qa.library.globalcastmd.com/watch/impact-of-cryoanalgesia-use-during-minimally-invasive-pectus-excavatum-repair-on-hospital-days-and-total-hospital-costs-among-pediatric-patients-7862?t=11)
- "The study aimed to evaluate hospital cost and length of stay for patients undergoing minimally invasive repair of pectus excavatum plus cryoanalgesia" — Cecilia Gigena (epidemiological) [Ep 38 · 0:11](https://qa.library.globalcastmd.com/watch/impact-of-cryoanalgesia-use-during-minimally-invasive-pectus-excavatum-repair-on-hospital-days-and-total-hospital-costs-among-pediatric-patients-7862?t=11)
- "The study included 44 patients total, with 29 undergoing cryoanalgesia" — Cecilia Gigena (epidemiological) [Ep 38 · 0:26](https://qa.library.globalcastmd.com/watch/impact-of-cryoanalgesia-use-during-minimally-invasive-pectus-excavatum-repair-on-hospital-days-and-total-hospital-costs-among-pediatric-patients-7862?t=26)
- "Patients who underwent cryoanalgesia had significantly less length of stay compared to those without cryoanalgesia" — Cecilia Gigena (clinical) [Ep 38 · 0:26](https://qa.library.globalcastmd.com/watch/impact-of-cryoanalgesia-use-during-minimally-invasive-pectus-excavatum-repair-on-hospital-days-and-total-hospital-costs-among-pediatric-patients-7862?t=26)
- "Patients who underwent cryoanalgesia had significantly lower complication rates compared to those without cryoanalgesia" — Cecilia Gigena (clinical) [Ep 38 · 0:26](https://qa.library.globalcastmd.com/watch/impact-of-cryoanalgesia-use-during-minimally-invasive-pectus-excavatum-repair-on-hospital-days-and-total-hospital-costs-among-pediatric-patients-7862?t=26)
- "Patients who underwent cryoanalgesia had lower hospital costs than those without cryoanalgesia, though this difference was not statistically significant" — Cecilia Gigena (clinical) [Ep 38 · 0:39](https://qa.library.globalcastmd.com/watch/impact-of-cryoanalgesia-use-during-minimally-invasive-pectus-excavatum-repair-on-hospital-days-and-total-hospital-costs-among-pediatric-patients-7862?t=39)
- "Cryoanalgesia helps with pain management in pectus excavatum repair" — Cecilia Gigena (opinion) [Ep 38 · 0:48](https://qa.library.globalcastmd.com/watch/impact-of-cryoanalgesia-use-during-minimally-invasive-pectus-excavatum-repair-on-hospital-days-and-total-hospital-costs-among-pediatric-patients-7862?t=48)
- "Cryoanalgesia can help with hospital cost reduction in pectus excavatum repair" — Cecilia Gigena (opinion) [Ep 38 · 0:48](https://qa.library.globalcastmd.com/watch/impact-of-cryoanalgesia-use-during-minimally-invasive-pectus-excavatum-repair-on-hospital-days-and-total-hospital-costs-among-pediatric-patients-7862?t=48)
- "99% of pectus patients receive transthoracic echos reported as normal, but these studies have difficulty obtaining adequate windows to visualize the right side of the heart." — Dawn (clinical) [Ep 4 · 2:55](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=175)
- "Intraoperative TEE shows marked compression of the right heart chambers pre-operatively, with significant improvement in chamber dimensions post-operatively." — Dawn (clinical) [Ep 4 · 3:17](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=197)
- "Post-operative flow velocities through the right ventricular outflow tract are nearly triple pre-operative values." — Dawn (clinical) [Ep 4 · 3:43](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=223)
- "Left ventricular output also improves significantly when right-sided flow increases, because the heart functions as a pump." — Dawn (clinical) [Ep 4 · 3:56](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=236)
- "In older pectus patients, cardiac output can improve from 55% (normal range) to 77% after repair." — Dawn (clinical) [Ep 4 · 4:30](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=270)
- "Cardiac contractility, synchrony, and segmental excursion all show significant improvement post-operatively." — Dawn (clinical) [Ep 4 · 4:57](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=297)
- "In a series of 168 patients, minimally invasive repair produced a 30% increase in cardiac output, while open repair showed less improvement (24% overall)." — Dawn (clinical) [Ep 4 · 5:28](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=328)
- "Open repair patients show less cardiac output improvement than minimally invasive patients, likely because the open group includes more cases of malunion and other complex issues." — Dawn (opinion) [Ep 4 · 5:28](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=328)
- "Standard Bruce protocol ischemic stress testing is not appropriate for pectus evaluation; cardiopulmonary exercise testing with VO2 measurement is required." — Dawn (clinical) [Ep 4 · 6:24](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=384)
- "VO2 max and anaerobic VO2 are very abnormal in pectus patients, while other cardiopulmonary parameters remain normal." — Dawn (clinical) [Ep 4 · 6:58](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=418)
- "A French study of 125 adults showed that cardiopulmonary exercise parameters statistically improve and normalize after surgical pectus repair." — Dawn (host_summary) [Ep 4 · 7:10](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=430)
- "Pectus patients show a flat stroke volume curve during exercise—they increase output initially by heart rate but cannot increase volume due to chest cage restriction." — Dawn (clinical) [Ep 4 · 7:33](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=453)
- "Malik's Easter Seals grant study at UCLA found that while some classes of pediatric pectus patients showed exercise deficits, a large percentage of children did not show problems on cardiopulmonary testing." — Dawn (host_summary) [Ep 4 · 13:46](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=826)
- "Compensation mechanisms in children appear to work better than in adults; older patients show stronger deficits on exercise testing." — Dawn (opinion) [Ep 4 · 14:05](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=845)
- "Some pectus patients are completely asymptomatic as children but progress to become symptomatic as they age, while others are symptomatic from a young age." — Dawn (clinical) [Ep 4 · 14:15](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=855)
- "Ehlers-Danlos type 4 (vascular type) does not typically present with pectus excavatum as a skeletal manifestation." (clinical) [Ep 4 · 10:31](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=631)
- "Ehlers-Danlos type 4 involves internal tissue fragility, requiring specially managed repairs if surgery is considered." (clinical) [Ep 4 · 10:52](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=652)
- "Genetic testing should be used to confirm Ehlers-Danlos type 4; if genetic testing is normal but clinical suspicion remains high, skin biopsy may be considered." (guideline) [Ep 4 · 11:09](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=669)
- "Patients often confuse hypermobile and vascular types of Ehlers-Danlos based on visible veins or family history of aortic aneurysm, neither of which indicates vascular type." (clinical) [Ep 4 · 11:33](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=693)
- "Younger children have more flexible chest walls, allowing repair with less force (described as 'a popsicle stick'), while adults are rigid and experience tremendous pain." — Dawn (clinical) [Ep 4 · 16:22](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=982)
- "Korean centers routinely repair pectus in 3-5 year old children using very small bars and report good outcomes." — Dawn (host_summary) [Ep 4 · 16:37](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=997)
- "The trend in the United States has shifted from repairing young children to operating on older populations." — Dawn (epidemiological) [Ep 4 · 16:49](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=1009)
- "Donald Nuss's early series included patients as young as 3 years old and did not report high recurrence rates." (host_summary) [Ep 4 · 17:12](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=1032)
- "The institution where Donald Nuss practices has moved away from operating on young children, suggesting they may have encountered more issues than reported in the initial series." — Dawn (opinion) [Ep 4 · 18:08](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=1088)
- "Vacuum bell therapy works best in patients with very flexible chest walls who wear the device religiously." — Dawn (clinical) [Ep 4 · 19:23](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=1163)
- "Patient compliance with vacuum bell therapy varies widely, with some children tolerating only 10 minutes of use despite parental bribes." — Dawn (clinical) [Ep 4 · 19:34](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=1174)
- "For a 5 year old with pectus, vacuum bell therapy is a reasonable alternative to surgery." — Dawn (opinion) [Ep 4 · 19:58](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=1198)
- "95% of patients who come to Dawn's office ultimately choose surgery." — Dawn (epidemiological) [Ep 4 · 21:56](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=1316)
- "Dawn's practice has selection bias because she primarily sees symptomatic adult patients; thousands of adults with pectus may be asymptomatic." — Dawn (opinion) [Ep 4 · 21:10](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=1270)
- "When asymptomatic adolescents with severe pectus are counseled in depth, they often reveal subtle symptoms they hadn't recognized, such as not performing as well as their friends." — Dawn (clinical) [Ep 4 · 22:03](https://qa.library.globalcastmd.com/watch/pectus-physiologic-consequences-and-research-688?t=1323)
- "About 30% of Don's practice is revision pectus surgery, not all his own cases." — Don (clinical) [Ep 3 · 1:01](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=61)
- "Reported recurrence rates vary widely; some sites report almost no recurrence, others fairly high rates. The true incidence is unknown because many patients don't report back to centers." — Don (epidemiological) [Ep 3 · 1:20](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=80)
- "In Don's original adult open Ravitch series with Fonkalsrud at UCLA, the reported recurrence rate was about 5%, but over the last 10 years at least 20 patients from that series contacted him wanting revision because they recurred." — Don (epidemiological) [Ep 3 · 1:50](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=110)
- "Nuss revision cases recur for different reasons than open Ravitch cases: Nuss failures are more related to technical issues (bar positioning, bar rotation, early removal), whereas open cases involve healing issues, malunion, and regression." — Don (clinical) [Ep 3 · 2:06](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=126)
- "Once Nuss bars rotate, their ability to put pressure and elevate the chest wall is lost, and they usually cause pain." — Don (clinical) [Ep 3 · 3:25](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=205)
- "The most common Nuss failure Don sees in adults is lateral stripping: the bar looks perfect on frontal X-ray but has stripped posteriorly on lateral view, losing forward elevation and sometimes causing cardiac obstruction or compression of lower lobes, diaphragm, and liver." — Don (clinical) [Ep 3 · 3:44](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=224)
- "In the adult population, the chest is often so stiff and rigid that the intercostal spaces cannot support the pressure of the bar, so they rip out, spread wider, and drop the bar in. Pressure also makes it easier for bars to rotate." — Don (clinical) [Ep 3 · 4:52](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=292)
- "Don uses forced sternal elevation (Rultract), reinforces intercostal spaces on heavier adults (initially only on spaces that stripped during bar placement, now preemptively if there is any chance of lateral stripping), fixes bars medially, uses multiple bars, and performs releasing osteotomies if elevation is inadequate." — Don (clinical) [Ep 3 · 5:22](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=322)
- "The Rultract is a retractor used to hold the chest up during internal mammary harvest for heart bypass; Don attaches a bone clamp to the sternum and lifts, creating an open space for dissection and reducing force during bar rotation." — Don (clinical) [Ep 3 · 6:05](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=365)
- "Don initially used the Rultract only on complicated cases but now uses it on almost all cases for safety and ease." — Don (clinical) [Ep 3 · 6:48](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=408)
- "Don reinforces intercostal spaces with FiberWire (a woven PTFE suture) in a figure-of-eight around the ribs and bar to prevent the ribs from separating and allowing the bar to drop in and strip further." — Don (clinical) [Ep 3 · 7:04](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=424)
- "About 30% of Don's patients now receive three bars to balance the defect. A single bar in the center is not enough for heavier, stiffer chests and causes tremendous pain; balancing the defect reduces pain and risk of movement and stripping." — Don (clinical) [Ep 3 · 7:35](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=455)
- "Don uses FiberWire (not stabilizers) to catch at least three ribs. On lower bars, he makes a small incision over the sternum, drills a hole, and passes suture to loop around the sternum and bar in the center to ensure bars do not rotate." — Don (clinical) [Ep 3 · 8:02](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=482)
- "In a 28-year-old revision case with severe pain, residual defect (Haller 4.6), and rotated 17-inch bar with lateral stabilizer, Don removed the long bar, used the Rultract, reinforced intercostal spaces, and placed two 14-inch bars, achieving good correction." — Don (clinical) [Ep 3 · 8:35](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=515)
- "In a 20-year-old with two bars that failed to elevate and developed a left-sided carinatum, Don removed the two 15-inch bars, used the Rultract, and placed two 12.5-inch bars. The carinatum was compressible on exam and was tied down to the bar with sutures, correcting the defect." — Don (clinical) [Ep 3 · 9:54](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=594)
- "A 49-year-old woman had three prior OR visits (two Nuss attempts and a reoperation for bleeding), severe pain, residual Haller 4.9, and cardiac compression from an intrathoracic, laterally migrated bar. Don spent about 4 hours lysing adhesions (pericardium stuck, history of pericarditis and effusion), then used the Rultract to lift the chest and placed two bars with intercostal reinforcement. She did well postoperatively." — Don (clinical) [Ep 3 · 11:33](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=693)
- "The hosts report that since visiting Mayo and attending the Phoenix course, they use the Rultract on almost all cases, finding it makes dissection easier, safer, and provides better visualization." (opinion) [Ep 3 · 14:25](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=865)
- "Don's bar-length criterion: 2–3 cm overlap around the lateral chest curve, catching one of the side ribs but not wrapping all the way to the back. This is harder to judge in women (breast tissue) or heavier patients." — Don (clinical) [Ep 3 · 15:28](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=928)
- "In Don's series of over 300 adults (more than 200 over age 30), almost all patients under 30 could be lifted with the Rultract and Lorenz dissector (only a couple could not). In the over-30 group, 88.7% could be lifted, but 11–12% would not lift and required osteotomies." — Don (epidemiological) [Ep 3 · 18:46](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=1126)
- "If a chest does not lift with forced elevation, bars alone will not make it lift—they are not strong enough. Patients with bars that did not lift initially will not lift eventually by keeping the bars in longer." — Don (clinical) [Ep 3 · 20:33](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=1233)
- "Don performs a mini-osteotomy when the chest will not lift: makes cuts to free the cartilages from the sternum at the site that won't lift, then shortens the cartilages (like a cartilage-sparing Ravitch) to allow them to come back down. Sometimes a second releasing cut is needed." — Don (clinical) [Ep 3 · 20:52](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=1252)
- "Don often places a small plate across the osteotomy site if it is trying to lift up." — Don (clinical) [Ep 3 · 21:39](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=1299)
- "In a bodybuilder with a very severe, completely rigid chest, Don attached two clamps in separate areas and tried to lift, but snapped the sternum in half. He then performed a small midline incision, finished the sternal osteotomy, released a couple of side cartilages, and achieved a nice repair." — Don (clinical) [Ep 3 · 21:48](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=1308)
- "In an older gentleman with a severe round defect, the chest lifted except for one lower left rib cartilage that was stuck. Don made a small incision over that cartilage, sliced it, and the chest came up. Sometimes only one or two sites are fixing the chest, so a big conversion is not always necessary." — Don (clinical) [Ep 3 · 22:31](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=1351)
- "Don calls his approach a 'hybrid repair': once the chest is lifted (with or without osteotomies), he places bars just like a regular Nuss patient." — Don (clinical) [Ep 3 · 23:01](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=1381)
- "Don initially did not plate osteotomy sites (used suture like in old Ravitch), but found they would knob up and not look cosmetically nice. Now he places a small plate to stabilize them, and they heal very nicely." — Don (clinical) [Ep 3 · 23:13](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=1393)
- "In older patients with calcified cartilage, the classic cartilage-sparing perichondrial dissection is often not feasible because everything is stuck and messy. Don starts with a slicing osteotomy to free the cartilage from the sternum, then when the sternum is up, the cartilage is often redundant and must be shortened by taking a segment out." — Don (clinical) [Ep 3 · 24:39](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=1479)
- "If osteotomies are needed, they must be done open (not thoracoscopically). Don uses an osteotome to open the cartilage, but sometimes the tissue is bone and he must use a mini sternal saw." — Don (clinical) [Ep 3 · 26:01](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=1561)
- "After an osteotomy, the rib must be stabilized with a stitch or plate; otherwise it will not stay down and will elevate and stick up because the chest alignment has changed." — Don (clinical) [Ep 3 · 28:37](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=1717)
- "Don tried doing carinatum repairs minimally invasively from the inside but did not get good cosmetic results. Now, with a small incision, he can do a lot and achieve very nice results." — Don (opinion) [Ep 3 · 29:05](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=1745)
- "Redo open pectus cases fall into three categories: those that didn't get support and just fell in (can be re-Nussed, lift nicely); those that are fixed and require osteotomies; and big disasters with holes in the chest and malunion." — Don (clinical) [Ep 3 · 30:09](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=1809)
- "Patients with any evidence of hernia, malunion, or thoracic dystrophy are automatically open cases. All others are attempted with the Rultract like primaries; if they lift, bars are placed; if not, Don converts to a small incision with osteotomies." — Don (clinical) [Ep 3 · 30:42](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=1842)
- "Don preps all redo open cases with groins exposed in case of life-threatening bleeding, allowing cannulation for bypass through the groin." — Don (clinical) [Ep 3 · 31:40](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=1900)
- "Don plates all redo open cases anteriorly in addition to placing posterior bars. He learned early on that patients who had only bars and no anterior plating recurred again when the bars were removed." — Don (clinical) [Ep 3 · 31:49](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=1909)
- "A 45-year-old man had a Ravitch two years prior; his Haller is now 8.3, two points higher than before surgery. Don found one abnormally fused spot, cut it, placed a plate, and used three bars. The patient elevated quite nicely with no other malunion." — Don (clinical) [Ep 3 · 32:13](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=1933)
- "Malunion or pseudarthrosis is identified on CT by ribs not attached to the midline. Physical exam is more reliable than CT for assessing malunion. Worst-case scenario is a floating sternum." — Don (clinical) [Ep 3 · 33:05](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=1985)
- "Patients with malunion have a lot of pain and inability to Valsalva. The Haller index can be almost normal, so they are often told by multiple physicians that they are fine despite having symptoms." — Don (clinical) [Ep 3 · 33:53](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=2033)
- "Reconstruction of malunion cases requires stabilization, often with bone graft or methylmethacrylate filler to fill spaces, mesh, and definitely plating." — Don (clinical) [Ep 3 · 34:12](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=2052)
- "A 28-year-old had a Ravitch at age 15 and chronic chest pain since. On exam, severe malunion with the whole chest wall moving; paradoxical movement on coughing. Haller index only 3.4. Intraoperatively, sternum completely separate from both sides of chest wall. Don placed two posterior bars, cleaned edges to viable tissue, plated across, and used biologic mesh in the middle because the pec muscles had atrophied and lateralized, leaving a segment that wouldn't cover the plates. Covering everything is important in skinny patients." — Don (clinical) [Ep 3 · 34:30](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=2070)
- "A 62-year-old runner had a prior Ravitch with excision, two pectus bars in place, and a big hole in the front of his chest. He could see his heart falling out when running. Don laparoscopically mobilized omentum, pulled it through the diaphragm, used methylmethacrylate to recreate the lower chest wall, secured it with plating, and covered with omentum. At 1.5 years postop, no recurrence, no symptoms, back to running marathons." — Don (clinical) [Ep 3 · 36:09](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=2169)
- "A 47-year-old woman (referred by Doctor Garcia) had a Ravitch with Bioridge plating about a year prior, severe chronic pain, Haller 4.0. CT showed inflammatory fibrous mass. Intraoperatively, partially disintegrated material behind the sternum, between cartilages, free edge with malunion, nothing healed. Don debrided to viable tissue, placed posterior bars, used cadaveric bone graft paste with biologic mesh to fill spaces, and stabilized lower detached costal cartilages with titanium plating. Bars not yet removed; chronic pain is a big problem and stabilization does not always fix it." — Don (clinical) [Ep 3 · 37:46](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=2266)
- "A 50-year-old trumpet player had a Ravitch with revision three years prior, has been on disability with chronic narcotic dependence, cannot play trumpet or breathe well. Seen by 10 physicians who told him he was fine. Inspiratory Haller 2.2, but expiratory Haller 5.0 with collapse of the whole left side and a huge hole. Intraoperatively, lung herniating through chest wall, recurrence and collapse of right side with no support into the pericardium. Don used methylmethacrylate, posterior bars, and anterior plating. Patient did very well, back to playing trumpet and normal life. Bars removed at 2 years; anterior plates left in; no recurrence." — Don (clinical) [Ep 3 · 39:42](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=2382)
- "When deciding how many revisions are too many, it depends on what has been done. If bars were placed and then removed and the patient collapsed, there are other issues to address. If a patient has had bars, plating, and multiple procedures and is still collapsing—especially with a connective tissue disorder or a chest that won't heal—you start getting into infections, more osteonecrosis, and other issues, and it becomes hard to know when to stop." — Don (opinion) [Ep 3 · 42:00](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=2520)
- "Don and Doctor Sawyer have a joint patient who has been operated on 8 times (many by Don). It's hard because you get into a cycle with these patients, chasing one problem area after another. Many are litigious, which can become a big issue." — Don (clinical) [Ep 3 · 42:42](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=2562)
- "Doctor Garcia emphasizes that the best operation is the first operation. Despite the Nuss procedure appearing simple, there is a significant learning curve, and it is not a 'see one, do one' operation. This has not received the necessary attention." — Garcia (opinion) [Ep 3 · 43:10](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=2590)
- "Pain is a big issue in pectus revision surgery. Many patients mentioned by Don had chronic pain requiring narcotics. One reason the hosts invited Don was his ambitious goal of minimizing pain not just initially but throughout the hospital course." — Garcia (host_summary) [Ep 3 · 43:20](https://qa.library.globalcastmd.com/watch/pectus-surgical-approaches-for-failed-repair-689?t=2600)
- "The study is a multi-center retrospective study conducted in France describing pectus arcuatum" — Cecilia Gigena (epidemiological) [Ep 40 · 0:11](https://qa.library.globalcastmd.com/watch/pectus-arcuatum-a-pectus-unlike-any-other-7899?t=11)
- "The study included 34 patients with pectus arcuatum" — Cecilia Gigena (epidemiological) [Ep 40 · 0:20](https://qa.library.globalcastmd.com/watch/pectus-arcuatum-a-pectus-unlike-any-other-7899?t=20)
- "47% of patients needed chest x-ray or CT scan to confirm the diagnosis of pectus arcuatum" — Cecilia Gigena (clinical) [Ep 40 · 0:20](https://qa.library.globalcastmd.com/watch/pectus-arcuatum-a-pectus-unlike-any-other-7899?t=20)
- "35% of pectus arcuatum patients were associated with a malformation" — Cecilia Gigena (epidemiological) [Ep 40 · 0:29](https://qa.library.globalcastmd.com/watch/pectus-arcuatum-a-pectus-unlike-any-other-7899?t=29)
- "Noonan syndrome is an associated malformation seen with pectus arcuatum" — Cecilia Gigena (clinical) [Ep 40 · 0:29](https://qa.library.globalcastmd.com/watch/pectus-arcuatum-a-pectus-unlike-any-other-7899?t=29)
- "Scoliosis is an associated malformation seen with pectus arcuatum" — Cecilia Gigena (clinical) [Ep 40 · 0:29](https://qa.library.globalcastmd.com/watch/pectus-arcuatum-a-pectus-unlike-any-other-7899?t=29)
- "The best treatment for pectus arcuatum was surgical correction that included a sternotomy" — Cecilia Gigena (clinical) [Ep 40 · 0:29](https://qa.library.globalcastmd.com/watch/pectus-arcuatum-a-pectus-unlike-any-other-7899?t=29)
- "Pectus arcuatum should not be confused with pectus carinatum as they are different conditions" — Cecilia Gigena (clinical) [Ep 40 · 0:41](https://qa.library.globalcastmd.com/watch/pectus-arcuatum-a-pectus-unlike-any-other-7899?t=41)
- "The study was a retrospective cohort study that looked at 62 patients from 2017 to 2023" — Lizzie Lee (epidemiological) [Ep 47 · 0:19](https://qa.library.globalcastmd.com/watch/six-years-of-quality-improvement-in-pectus-excavatum-repair-implementation-of-intercostal-nerve-cryoablation-and-eras-protocols-for-patients-undergoing-nuss-procedure-10353?t=19)
- "Intercostal nerve cryoablation significantly reduced hospital stays in pectus excavatum patients undergoing the Nuss procedure" — Lizzie Lee (clinical) [Ep 47 · 0:25](https://qa.library.globalcastmd.com/watch/six-years-of-quality-improvement-in-pectus-excavatum-repair-implementation-of-intercostal-nerve-cryoablation-and-eras-protocols-for-patients-undergoing-nuss-procedure-10353?t=25)
- "Intercostal nerve cryoablation significantly reduced opioid use in pectus excavatum patients undergoing the Nuss procedure" — Lizzie Lee (clinical) [Ep 47 · 0:25](https://qa.library.globalcastmd.com/watch/six-years-of-quality-improvement-in-pectus-excavatum-repair-implementation-of-intercostal-nerve-cryoablation-and-eras-protocols-for-patients-undergoing-nuss-procedure-10353?t=25)
- "Intercostal nerve cryoablation slightly increased surgery time in pectus excavatum patients undergoing the Nuss procedure" — Lizzie Lee (clinical) [Ep 47 · 0:25](https://qa.library.globalcastmd.com/watch/six-years-of-quality-improvement-in-pectus-excavatum-repair-implementation-of-intercostal-nerve-cryoablation-and-eras-protocols-for-patients-undergoing-nuss-procedure-10353?t=25)
- "Intercostal nerve cryoablation slightly increased early postoperative pain in pectus excavatum patients undergoing the Nuss procedure" — Lizzie Lee (clinical) [Ep 47 · 0:25](https://qa.library.globalcastmd.com/watch/six-years-of-quality-improvement-in-pectus-excavatum-repair-implementation-of-intercostal-nerve-cryoablation-and-eras-protocols-for-patients-undergoing-nuss-procedure-10353?t=25)
- "Adding ERAS protocols to cryoablation further reduced opioid needs in pectus excavatum patients undergoing the Nuss procedure" — Lizzie Lee (clinical) [Ep 47 · 0:36](https://qa.library.globalcastmd.com/watch/six-years-of-quality-improvement-in-pectus-excavatum-repair-implementation-of-intercostal-nerve-cryoablation-and-eras-protocols-for-patients-undergoing-nuss-procedure-10353?t=36)
- "Adding ERAS protocols to cryoablation further reduced early pain scores in pectus excavatum patients undergoing the Nuss procedure" — Lizzie Lee (clinical) [Ep 47 · 0:36](https://qa.library.globalcastmd.com/watch/six-years-of-quality-improvement-in-pectus-excavatum-repair-implementation-of-intercostal-nerve-cryoablation-and-eras-protocols-for-patients-undergoing-nuss-procedure-10353?t=36)
- "Combining cryoablation and ERAS protocols leads to better outcomes and pain management in pectus excavatum patients undergoing the Nuss procedure" — Lizzie Lee (opinion) [Ep 47 · 0:40](https://qa.library.globalcastmd.com/watch/six-years-of-quality-improvement-in-pectus-excavatum-repair-implementation-of-intercostal-nerve-cryoablation-and-eras-protocols-for-patients-undergoing-nuss-procedure-10353?t=40)
- "The study was a single institution retrospective chart review conducted from 2012 to 2023" — Alex Halpern (clinical) [Ep 48 · 0:13](https://qa.library.globalcastmd.com/watch/vacuum-bell-therapy-for-pectus-excavatum-long-term-experience-at-a-single-center-10404?t=13)
- "278 patients were included in the analysis" — Alex Halpern (epidemiological) [Ep 48 · 0:20](https://qa.library.globalcastmd.com/watch/vacuum-bell-therapy-for-pectus-excavatum-long-term-experience-at-a-single-center-10404?t=20)
- "31 patients had excellent corrections with vacuum bell therapy" — Alex Halpern (clinical) [Ep 48 · 0:23](https://qa.library.globalcastmd.com/watch/vacuum-bell-therapy-for-pectus-excavatum-long-term-experience-at-a-single-center-10404?t=23)
- "247 patients had non-excellent corrections with vacuum bell therapy" — Alex Halpern (clinical) [Ep 48 · 0:23](https://qa.library.globalcastmd.com/watch/vacuum-bell-therapy-for-pectus-excavatum-long-term-experience-at-a-single-center-10404?t=23)
- "Initial chest depth less than 1.5 centimeters is a predictor of positive outcomes" — Alex Halpern (clinical) [Ep 48 · 0:29](https://qa.library.globalcastmd.com/watch/vacuum-bell-therapy-for-pectus-excavatum-long-term-experience-at-a-single-center-10404?t=29)
- "Chest wall flexibility is a predictor of positive outcomes" — Alex Halpern (clinical) [Ep 48 · 0:29](https://qa.library.globalcastmd.com/watch/vacuum-bell-therapy-for-pectus-excavatum-long-term-experience-at-a-single-center-10404?t=29)
- "Excellent correction was more common in children 8 to 12.9 years old" — Alex Halpern (clinical) [Ep 48 · 0:29](https://qa.library.globalcastmd.com/watch/vacuum-bell-therapy-for-pectus-excavatum-long-term-experience-at-a-single-center-10404?t=29)
- "Excellent correction in children with pectus excavatum treated with vacuum bell therapy is uncommon" — Alex Halpern (opinion) [Ep 48 · 0:41](https://qa.library.globalcastmd.com/watch/vacuum-bell-therapy-for-pectus-excavatum-long-term-experience-at-a-single-center-10404?t=41)
- "Improved outcomes are seen in younger patients with more mild defects and greater chest wall flexibility" — Alex Halpern (clinical) [Ep 48 · 0:41](https://qa.library.globalcastmd.com/watch/vacuum-bell-therapy-for-pectus-excavatum-long-term-experience-at-a-single-center-10404?t=41)
- "In pectus excavatum clinic, skeletal evaluation for Marfan syndrome includes examination for wrist sign (thumb and pinky finger overlap when wrapped around wrist) and thumb protrusion past the ulnar border to evaluate for long bone overgrowth relative to trunk." (clinical) [Ep 7 · 0:21](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=21)
- "Arm span to height ratios and upper to lower segment ratios are evaluated as part of Marfan syndrome skeletal assessment." (clinical) [Ep 7 · 1:00](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=60)
- "Skeletal findings evaluated for Marfan syndrome include pectus excavatum, pectus carinatum, scoliosis, and hind foot deformities." (clinical) [Ep 7 · 1:07](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=67)
- "The cardiac risk associated with Marfan syndrome includes aortic dissection and mitral valve prolapse, as well as retinal detachments." (clinical) [Ep 7 · 1:19](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=79)
- "Diagnosis of Marfan syndrome is largely centered on cardiac findings, with echocardiogram or MRI as main tools to evaluate for dilated aortic root." (clinical) [Ep 7 · 1:38](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=98)
- "Lens dislocations are evaluated as part of Marfan syndrome assessment, and fibrillin gene testing is performed in cases with suggestive findings." (clinical) [Ep 7 · 1:55](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=115)
- "In patients with Marfan-like characteristics, evaluation may be extended to other genetic syndromes involving TGF beta signaling, which is implicated in aortic remodeling and long bone overgrowth." (clinical) [Ep 7 · 2:05](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=125)
- "Ehlers-Danlos syndrome is by far the more common condition evaluated in pectus patients compared to Marfan syndrome." (epidemiological) [Ep 7 · 2:27](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=147)
- "Ehlers-Danlos syndrome represents a grouping of related conditions affecting connective tissue, not a single condition." (clinical) [Ep 7 · 2:45](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=165)
- "Classic type Ehlers-Danlos is due to defects in collagen 5 and is characterized by joint hypermobility and abnormal skin that is fragile, thin, with weak and papery thin scars." (clinical) [Ep 7 · 3:00](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=180)
- "Vascular type Ehlers-Danlos is caused by mutations in collagen 3 and is characterized by internal organ fragility rather than hypermobile joints." (clinical) [Ep 7 · 3:17](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=197)
- "Vascular Ehlers-Danlos is one of the least common conditions seen in pectus clinic." (epidemiological) [Ep 7 · 3:39](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=219)
- "For vascular Ehlers-Danlos, screening looks for family history or personal history of ruptures (bowel, aortic, or uterine rupture)." (clinical) [Ep 7 · 3:52](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=232)
- "Genetic testing for vascular Ehlers-Danlos is 99% sensitive." (clinical) [Ep 7 · 4:07](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=247)
- "The hypermobile type of Ehlers-Danlos is what is typically evaluated in pectus clinic, characterized by very flexible patients." (clinical) [Ep 7 · 4:23](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=263)
- "The Beighton score is a test of 9 different joints, scored 1 for each side except the hips, used to formally assess hypermobility." (clinical) [Ep 7 · 4:41](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=281)
- "Beighton score criteria include: hyperextension of arms past 10 degrees, hyperextension of pinky past 90 degrees, apposition of thumb to forearm, hyperextension of knee past 10 degrees (all scored bilaterally for 8 points), and placing hands flat on floor without bending knees (assessing hip hypermobility)." (clinical) [Ep 7 · 4:52](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=292)
- "Five or more hypermobile joints on the Beighton score meets criteria for generalized hypermobility." (clinical) [Ep 7 · 5:27](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=327)
- "Additional findings evaluated for hypermobile Ehlers-Danlos include mild skin changes (mild hyperextensibility, easy bruising, scarring abnormalities, striae) and family history of hypermobility." (clinical) [Ep 7 · 5:35](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=335)
- "The dividing line between being flexible and having Ehlers-Danlos may be very fuzzy; diagnosis looks for similar findings in family members and presence of clinical problems." (opinion) [Ep 7 · 6:01](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=361)
- "Clinical problems associated with hypermobile Ehlers-Danlos include: loose joints that dislocate, chronic pain, chronic headaches and migraines, temporomandibular joint dysfunction, easy bruising and bleeding, orthostatic hypotension or dizziness with standing, episodes of racing heartbeat, chronic constipation with irritable bowel syndrome, panic and anxiety disorders, and sleeping problems." (clinical) [Ep 7 · 6:25](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=385)
- "Most adult patients with hypermobile Ehlers-Danlos have almost all of the associated problems (pain, headaches, TMJ, bleeding, orthostatic issues, IBS, anxiety, sleep problems)." (epidemiological) [Ep 7 · 7:12](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=432)
- "In children with hypermobile Ehlers-Danlos, problems may be very mild or not evident, but may begin to emerge during puberty, which may coincide with when they consider pectus surgery." (clinical) [Ep 7 · 7:17](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=437)
- "The chronic pain aspect of hypermobile Ehlers-Danlos can affect whether patients are at risk for more pain from pectus surgery." (clinical) [Ep 7 · 7:33](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=453)
- "Hypermobility is a risk factor for fibromyalgia; 50% of teenagers diagnosed with fibromyalgia have hypermobility." (epidemiological) [Ep 7 · 7:42](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=462)
- "Fibromyalgia involves central sensitivity to pain, meaning patients are unable to filter out unwanted pain signals in the same way as other persons." (clinical) [Ep 7 · 7:56](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=476)
- "A hypermobile patient may be at risk for having more problems with chronic pain due to central pain sensitivity mechanisms." (clinical) [Ep 7 · 8:08](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=488)
- "One clinician's screening approach for pectus patients includes checking for double-jointedness, appearance of Marfan disease, arachnodactyly, and striae, with referral to genetics if findings are present." (clinical) [Ep 7 · 8:41](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=521)
- "This was a prospective pilot study" — Lizzie Lee (clinical) [Ep 49 · 0:12](https://qa.library.globalcastmd.com/watch/cardiopulmonary-impact-of-the-minimally-invasive-repair-of-pectus-excavatum-in-pediatric-patients-a-prospective-pilot-study-10436?t=12)
- "Study included patients under 18 who had cardiopulmonary exercise testing before minimally invasive repair of pectus excavatum and then after removal of their pectus bar" — Lizzie Lee (clinical) [Ep 49 · 0:12](https://qa.library.globalcastmd.com/watch/cardiopulmonary-impact-of-the-minimally-invasive-repair-of-pectus-excavatum-in-pediatric-patients-a-prospective-pilot-study-10436?t=12)
- "25 patients total completed both tests" — Lizzie Lee (clinical) [Ep 49 · 0:24](https://qa.library.globalcastmd.com/watch/cardiopulmonary-impact-of-the-minimally-invasive-repair-of-pectus-excavatum-in-pediatric-patients-a-prospective-pilot-study-10436?t=24)
- "Results showed a significant improvement in O2 pulse after the repair" — Lizzie Lee (clinical) [Ep 49 · 0:24](https://qa.library.globalcastmd.com/watch/cardiopulmonary-impact-of-the-minimally-invasive-repair-of-pectus-excavatum-in-pediatric-patients-a-prospective-pilot-study-10436?t=24)
- "O2 pulse is a measure of how much oxygen the heart pumps per beat" — Lizzie Lee (clinical) [Ep 49 · 0:24](https://qa.library.globalcastmd.com/watch/cardiopulmonary-impact-of-the-minimally-invasive-repair-of-pectus-excavatum-in-pediatric-patients-a-prospective-pilot-study-10436?t=24)
- "Improved O2 pulse suggests better heart function after the repair" — Lizzie Lee (clinical) [Ep 49 · 0:24](https://qa.library.globalcastmd.com/watch/cardiopulmonary-impact-of-the-minimally-invasive-repair-of-pectus-excavatum-in-pediatric-patients-a-prospective-pilot-study-10436?t=24)
- "The improvement may reflect relief of cardiac compression that was present preoperatively due to pectus excavatum" — Lizzie Lee (opinion) [Ep 49 · 0:37](https://qa.library.globalcastmd.com/watch/cardiopulmonary-impact-of-the-minimally-invasive-repair-of-pectus-excavatum-in-pediatric-patients-a-prospective-pilot-study-10436?t=37)
- "Minimally invasive repair of pectus excavatum does appear to improve heart performance during exercise" — Lizzie Lee (clinical) [Ep 49 · 0:43](https://qa.library.globalcastmd.com/watch/cardiopulmonary-impact-of-the-minimally-invasive-repair-of-pectus-excavatum-in-pediatric-patients-a-prospective-pilot-study-10436?t=43)
- "Haller index of 3.25 originated from a retrospective study by Alec Haller in the 1980s comparing cases he fixed versus those he did not" — Holcomb (clinical) [Ep 2 · 4:33](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=273)
- "The Haller index study was not an earth-shattering study at the time but has been used consistently for 30 years" — Holcomb (opinion) [Ep 2 · 5:10](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=310)
- "Psychosocial aspects of growing up are very important, and severe deformities should be fixed for psychosocial well-being regardless of symptoms" — Holcomb (opinion) [Ep 2 · 1:59](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=119)
- "Insurance companies require documented symptoms and a Haller index for approval of pectus repair" (guideline) [Ep 2 · 2:13](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=133)
- "Nickel allergy frequency in pectus patients is 2.8% (almost 3%) according to Doctor Nuss's group study of 1200 patients from 1987-2008" — Holcomb (host_summary) [Ep 2 · 24:18](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1458)
- "In a randomized trial of 110 patients, epidural catheters were removed within 24 hours or could not be placed in almost 25% of cases, even by experienced anesthesiologists" — Holcomb (host_summary) [Ep 2 · 18:18](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1098)
- "Epidural group had longer OR time due to catheter placement, more phone calls to anesthesia, and greater hospital charges compared to PCA" — Holcomb (host_summary) [Ep 2 · 17:44](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1064)
- "Pain scores generally favored epidural for the first 2 days, were flat on day 3, and favored PCA in the last couple of days" — Holcomb (host_summary) [Ep 2 · 18:04](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1084)
- "In Kansas City series of 168 patients over 6 years, there were 6 infections (3.6%), 5 required incision and drainage, 3 developed recurrent infections, and 1 required early bar removal" — Holcomb (clinical) [Ep 2 · 19:56](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1196)
- "Doctor Nuss feels results are better if bars are left in for 3 years based on his group's data showing improved outcomes with duration ≥24 months" — Holcomb (host_summary) [Ep 2 · 25:03](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1503)
- "Kansas City has performed 503 pectus excavatum repairs using subxiphoid incision technique with no cardiac injuries" — Holcomb (clinical) [Ep 2 · 25:36](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1536)
- "In Kansas City series of first 300 cases: 5% required two bars, 4% infection rate, 1.5% bar dislodgement or stabilizer discomfort requiring removal, 4 patients had bar rotation (early experience), 2 patients required chest tube, zero recurrences requiring reoperation, mean hospitalization 4 days" — Holcomb (clinical) [Ep 2 · 25:46](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1546)
- "There are approximately 14-15 reported cases of cardiac injury with the Nuss procedure worldwide" — Holcomb (epidemiological) [Ep 2 · 11:13](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=673)
- "Thoracoscopy is not that helpful for cardiac injury prevention according to Kansas City's experience, so they do not generally use it" — Holcomb (opinion) [Ep 2 · 13:06](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=786)
- "The subxiphoid incision technique involves making a small incision to insert a finger, removing the xiphoid process, lifting the sternum with a retractor, and feeling/guiding the bar as it passes above the heart" — Holcomb (clinical) [Ep 2 · 13:28](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=808)
- "For pectus carinatum, dynamic compression bracing requires less than 7.5 PSI pressure to correct the defect for appropriate candidacy" — Holcomb (clinical) [Ep 2 · 30:08](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1808)
- "Pectus carinatum bracing is typically worn 6-20 months, then transitioned to retainer mode (6-12 hours daily)" — Holcomb (clinical) [Ep 2 · 30:49](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1849)
- "Kansas City has braced 200 pectus carinatum patients with dynamic compression bracing and has performed very few (one or two) open repairs in the past 4 years" — Holcomb (clinical) [Ep 2 · 33:17](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1997)
- "The dynamic compression brace costs approximately $1500-2000 total, requiring purchase of both a kit (one-time) and the device" — Holcomb (clinical) [Ep 2 · 33:46](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=2026)
- "Transesophageal echo can be used to detect adhesions between heart and sternum, particularly useful in redo cases to avoid cardiac injury" (clinical) [Ep 2 · 15:29](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=929)
- "A bone hook can be used through the subxiphoid incision to lift the sternum and gain an additional 1-2 millimeters of space for bar passage in deep deformities" (clinical) [Ep 2 · 15:54](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=954)
- "Currarino-Silverman syndrome shows a comma deformity on lateral X-ray and requires open Ravitch-type repair" — Holcomb (clinical) [Ep 2 · 31:29](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1889)
- "Doctor Abramson in Buenos Aires has devised a minimally invasive operation for pectus carinatum" — Holcomb (host_summary) [Ep 2 · 31:53](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1913)
- "The magnetic mini-mover procedure (3MP) is in an FDA trial, 18 months into enrollment with all patients implanted, requiring another 18 months of data collection" — Holcomb (host_summary) [Ep 2 · 27:29](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1649)
- "A vacuum cup suction device is being used in Europe for pectus repair but is not approved in the United States" — Holcomb (clinical) [Ep 2 · 16:27](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=987)
- "Pectus excavatum repair is arguably the most painful operation that could be done in a child." — Victor Garcia (clinical) [Ep 5 · 2:48](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=168)
- "Approximately 15% of pectus patients had right ventricular ejection fractions less than 50% (normal is 50%)." — Michael Taylor (epidemiological) [Ep 5 · 21:34](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1294)
- "Patients with RV compression had depressed right ventricular ejection fractions, particularly when compression affected the free wall versus the groove between right atrium and right ventricle." — Michael Taylor (clinical) [Ep 5 · 23:25](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1405)
- "Haller found that patients with a Haller index greater than 3.25 were ones he operated on, but this was an observational retrospective study, not a rigorous scientific or prospective study." — Eric Crotty (clinical) [Ep 5 · 11:55](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=715)
- "There is a very large overlap between patients with normal chests and patients with pectus excavatum regarding Haller indices—normal patients can have technically abnormal Haller index without pectus, and vice versa." — Eric Crotty (clinical) [Ep 5 · 13:11](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=791)
- "The correction index (greater than 10%) shows no overlap between normal and abnormal patients, unlike the Haller index." — Eric Crotty (clinical) [Ep 5 · 13:38](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=818)
- "The depression index (greater than 0.2) accounts for variable chest shapes (barrel-shaped versus elliptical) and should be abnormal in pectus excavatum regardless of chest configuration." — Eric Crotty (clinical) [Ep 5 · 14:02](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=842)
- "Depending on the phase of respiration, the Haller index can change—some patients have abnormal indices at end expiration but normal indices at end inspiration despite clinical pectus excavatum." — Eric Crotty (clinical) [Ep 5 · 10:26](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=626)
- "Cardiac MRI can replace CT and echocardiogram, providing anatomical and functional evaluation without contrast in approximately 25 minutes." — Michael Taylor (clinical) [Ep 5 · 16:42](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1002)
- "Echocardiogram image quality in most pectus patients is atrocious—you can't see much of anything because the right ventricle and sternum are in the very near field of the transducer." — Michael Taylor (clinical) [Ep 5 · 18:40](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1120)
- "Cardiac MRI allows screening for valve disease and aortopathy, both part of the connective tissue spectrum, in addition to assessing pectus anatomy and cardiac function." — Michael Taylor (clinical) [Ep 5 · 17:38](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1058)
- "Kids can have right ventricular ejection fractions in the 40s and be asymptomatic; symptoms often don't manifest until very late in the disease process." — Michael Taylor (clinical) [Ep 5 · 24:31](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1471)
- "As kids with pectus age, the heart appears to get extruded into the left chest, though whether this is a growth developmental phenomenon is unknown." — Michael Taylor (clinical) [Ep 5 · 26:29](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1589)
- "A standard CT dose for pectus can deliver about 7 millisieverts of radiation, equivalent to about 2 years of background radiation in one scan." — Eric Crotty (clinical) [Ep 5 · 40:14](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=2414)
- "The earlier you get a CT and the higher the dose, the greater your long-term risk of developing malignancy; pediatric tissues divide more rapidly and have more time to develop DNA breaks." — Eric Crotty (clinical) [Ep 5 · 39:29](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=2369)
- "There is data suggesting an increased risk of malignancy long term from even one CT, and the younger you are, that risk increases over your lifetime." — Eric Crotty (epidemiological) [Ep 5 · 41:13](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=2473)
- "Children tolerate MRI very well; video goggle technology allows them to watch movies during the procedure, relieving anxiety." — Eric Crotty (clinical) [Ep 5 · 28:18](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1698)
- "MRI can be performed with pectus bars in place; there may be small localized susceptibility artifacts where the bar is on top of the heart, but they are minimal." — Michael Taylor (clinical) [Ep 5 · 29:09](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1749)
- "Insurance companies require some metric (abnormal pectus index plus evidence of cardiac dysfunction or abnormality) to approve coverage; providing multiple indices (Haller, correction, depression) plus cardiac dysfunction evidence has been effective in reversing denials." — Victor Garcia (guideline) [Ep 5 · 31:08](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1868)
- "Dr. Park in Korea, who performs the largest number of pectus repairs worldwide, argues that age 3 and older is safe for repair, and earlier is better." — Victor Garcia (host_summary) [Ep 5 · 42:03](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=2523)
- "When operating on younger patients, bars need to be shorter (not extending to mid-axillary line) to avoid impeding chest wall growth." — Victor Garcia (clinical) [Ep 5 · 42:31](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=2551)
- "Overcorrection from excavatum to carinatum can occur if repair is done too early, particularly in patients with connective tissue disorders (reported by Hopkins group)." — Victor Garcia (host_summary) [Ep 5 · 43:01](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=2581)
- "Dr. Park reports seeing fewer asymmetric pectus patients because he corrects them when they're younger, suggesting early correction may prevent asymmetry development." — Victor Garcia (host_summary) [Ep 5 · 43:35](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=2615)
- "The Cincinnati Children's approach is selective in identifying patients who will benefit from surgery and emphasizes helping patients and parents deal with pain and discomfort, minimizing workup risks (ionizing radiation), and mitigating chronic pain and substance abuse risk." — Victor Garcia (clinical) [Ep 5 · 2:48](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=168)
- "Standard preoperative workup includes cardiac MRI, genetics referral for connective tissue evaluation, and allergy testing (particularly for nickel and vanadium in bar materials)." — Becky Brown (guideline) [Ep 5 · 6:15](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=375)
- "Patients with connective tissue disorders and hyperflexibility may be at higher risk for chronic pain after pectus repair." — Becky Brown (clinical) [Ep 5 · 6:32](https://qa.library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=392)
- "Pectus excavatum is the most common congenital chest deformity" — Joshua Ramjist (epidemiological) [Ep 27 · 0:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=0)
- "Pectus excavatum affects one in 400 births" — Joshua Ramjist (epidemiological) [Ep 27 · 0:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=0)
- "Pectus excavatum affects patients at a vulnerable time in their lives in the childhood and adolescent years" — Joshua Ramjist (clinical) [Ep 27 · 0:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=0)
- "The Nuss procedure has been revolutionary in correcting pectus excavatum deformity" — Joshua Ramjist (opinion) [Ep 27 · 0:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=0)
- "Despite an excellent operation, the post-operative period has been plagued by pain which has resulted in significant morbidity and increased length of stay" — Joshua Ramjist (clinical) [Ep 27 · 0:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=0)
- "The five-point ERAS protocol spans the entirety of the patient's perioperative experience" — Joshua Ramjist (clinical) [Ep 27 · 1:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=60)
- "The protocol includes perioperative education and counseling to establish reasonable expectations using educational materials and a boarding pass" — Joshua Ramjist (clinical) [Ep 27 · 1:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=60)
- "The transitional pain service facilitates both pharmacologic and non-pharmacologic interventions to manage patient pain" — Joshua Ramjist (clinical) [Ep 27 · 1:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=60)
- "Multimodal analgesia intraoperatively includes serratus anterior block and cryoablation at the time of procedure" — Joshua Ramjist (clinical) [Ep 27 · 1:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=60)
- "A perioperative bowel regimen was included in the protocol" — Joshua Ramjist (clinical) [Ep 27 · 1:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=60)
- "The boarding pass was a primary instrument to facilitate shared decision making and establish a therapeutic relationship between the team and patients" — Joshua Ramjist (clinical) [Ep 27 · 1:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=60)
- "This is a single institution study at the Hospital for Sick Children with retrospective data for the pre-ERAS cohort and prospective data after implementation" — Joshua Ramjist (clinical) [Ep 27 · 3:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=180)
- "53 patients were recruited from August 2015 to December 2021" — Joshua Ramjist (clinical) [Ep 27 · 3:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=180)
- "All patients were approximately 15 years of age at the time of repair" — Joshua Ramjist (clinical) [Ep 27 · 3:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=180)
- "Haller indices were typically above 4.5" — Joshua Ramjist (clinical) [Ep 27 · 3:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=180)
- "92% of patients expressed satisfaction with their overall experience" — Joshua Ramjist (clinical) [Ep 27 · 3:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=180)
- "There was a significant decrease in length of stay by 50%, from 4 days to just under 2 days" — Joshua Ramjist (clinical) [Ep 27 · 4:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=240)
- "The mean length of stay was 1.8 days" — Joshua Ramjist (clinical) [Ep 27 · 4:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=240)
- "The majority of patients were leaving on post-operative day one" — Joshua Ramjist (clinical) [Ep 27 · 4:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=240)
- "There was a significant decrease in opioid consumption in the post-operative period from 6.36 to 3.12 morphine milliequivalents" — Joshua Ramjist (clinical) [Ep 27 · 4:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=240)
- "Surgery remains a team sport" — Joshua Ramjist (opinion) [Ep 27 · 5:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=300)
- "Successful surgical outcomes are predicated on a multi-disciplinary team working in each phase of care to optimize the patient's experience" — Joshua Ramjist (opinion) [Ep 27 · 5:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-joshua-ramjist-caps-presentation-6351?t=300)
- "A new index exists to measure the extent of sternal depression in pectus excavatum." — Sofía Tacchella (clinical) [Ep 30 · 0:00](https://qa.library.globalcastmd.com/watch/novedoso-indice-para-estimar-la-extensi-n-cefalocaudal-del-hundimiento-esternal-en-el-pectus-excavatum-el-ndice-titanic-6619?t=0)
- "The study was a retrospective study conducted at Clínica Mipetus, Buenos Aires, Argentina." — Sofía Tacchella (clinical) [Ep 30 · 1:00](https://qa.library.globalcastmd.com/watch/novedoso-indice-para-estimar-la-extensi-n-cefalocaudal-del-hundimiento-esternal-en-el-pectus-excavatum-el-ndice-titanic-6619?t=60)
- "Patients underwent minimally invasive repair of pectus excavatum between June 2020 and April 2022." — Sofía Tacchella (clinical) [Ep 30 · 1:15](https://qa.library.globalcastmd.com/watch/novedoso-indice-para-estimar-la-extensi-n-cefalocaudal-del-hundimiento-esternal-en-el-pectus-excavatum-el-ndice-titanic-6619?t=75)
- "The new index is called the Titanic Index." — Sofía Tacchella (clinical) [Ep 30 · 1:35](https://qa.library.globalcastmd.com/watch/novedoso-indice-para-estimar-la-extensi-n-cefalocaudal-del-hundimiento-esternal-en-el-pectus-excavatum-el-ndice-titanic-6619?t=95)
- "The Titanic Index evaluates the percentage of sternum located posterior to the anterior costal line on computed tomography." — Sofía Tacchella (clinical) [Ep 30 · 1:45](https://qa.library.globalcastmd.com/watch/novedoso-indice-para-estimar-la-extensi-n-cefalocaudal-del-hundimiento-esternal-en-el-pectus-excavatum-el-ndice-titanic-6619?t=105)
- "The index measures the craniocaudal extent of the depressed sternum." — Sofía Tacchella (clinical) [Ep 30 · 2:05](https://qa.library.globalcastmd.com/watch/novedoso-indice-para-estimar-la-extensi-n-cefalocaudal-del-hundimiento-esternal-en-el-pectus-excavatum-el-ndice-titanic-6619?t=125)
- "The study included 78 patients." — Sofía Tacchella (clinical) [Ep 30 · 2:15](https://qa.library.globalcastmd.com/watch/novedoso-indice-para-estimar-la-extensi-n-cefalocaudal-del-hundimiento-esternal-en-el-pectus-excavatum-el-ndice-titanic-6619?t=135)
- "The Haller index, correction index, and Titanic Index were measured in all patients." — Sofía Tacchella (clinical) [Ep 30 · 2:20](https://qa.library.globalcastmd.com/watch/novedoso-indice-para-estimar-la-extensi-n-cefalocaudal-del-hundimiento-esternal-en-el-pectus-excavatum-el-ndice-titanic-6619?t=140)
- "Patients were divided into two groups based on the number of implants placed." — Sofía Tacchella (clinical) [Ep 30 · 2:30](https://qa.library.globalcastmd.com/watch/novedoso-indice-para-estimar-la-extensi-n-cefalocaudal-del-hundimiento-esternal-en-el-pectus-excavatum-el-ndice-titanic-6619?t=150)
- "Group A received only two implants and comprised 47% of patients." — Sofía Tacchella (clinical) [Ep 30 · 2:40](https://qa.library.globalcastmd.com/watch/novedoso-indice-para-estimar-la-extensi-n-cefalocaudal-del-hundimiento-esternal-en-el-pectus-excavatum-el-ndice-titanic-6619?t=160)
- "Group B received three or more implants and comprised 53% of patients." — Sofía Tacchella (clinical) [Ep 30 · 2:50](https://qa.library.globalcastmd.com/watch/novedoso-indice-para-estimar-la-extensi-n-cefalocaudal-del-hundimiento-esternal-en-el-pectus-excavatum-el-ndice-titanic-6619?t=170)
- "A Titanic Index greater than 66% has a sensitivity of 93% for predicting the need for more than two implants." — Sofía Tacchella (clinical) [Ep 30 · 3:00](https://qa.library.globalcastmd.com/watch/novedoso-indice-para-estimar-la-extensi-n-cefalocaudal-del-hundimiento-esternal-en-el-pectus-excavatum-el-ndice-titanic-6619?t=180)
- "A Titanic Index greater than 66% has a specificity of 92% for predicting the need for more than two implants." — Sofía Tacchella (clinical) [Ep 30 · 3:15](https://qa.library.globalcastmd.com/watch/novedoso-indice-para-estimar-la-extensi-n-cefalocaudal-del-hundimiento-esternal-en-el-pectus-excavatum-el-ndice-titanic-6619?t=195)
- "The Titanic Index is a better predictor of the number of implants needed than the Haller index or the correction index." — Sofía Tacchella (clinical) [Ep 30 · 3:30](https://qa.library.globalcastmd.com/watch/novedoso-indice-para-estimar-la-extensi-n-cefalocaudal-del-hundimiento-esternal-en-el-pectus-excavatum-el-ndice-titanic-6619?t=210)
- "Minimally invasive repair of pectus excavatum is used to correct the most common thoracic anomaly in pediatric patients" — Britney Hegdy (clinical) [Ep 28 · 0:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=0)
- "Minimally invasive approach has been associated with decreased operative time, less blood loss and a quicker return to baseline compared to previous open approaches" — Britney Hegdy (clinical) [Ep 28 · 0:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=0)
- "MIRPE remains a painful procedure that historically required multiple adjuncts and a large amount of narcotics to achieve pain relief" — Britney Hegdy (clinical) [Ep 28 · 0:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=0)
- "A previous study at the institution found the use of cryo during minimally invasive repair lowered post-operative opioid use and hospital length of stay without increasing complications" — Britney Hegdy (clinical) [Ep 28 · 0:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=0)
- "Cryoablation is performed thoracoscopically using cryo nerve block probes under direct visualization" — Britney Hegdy (clinical) [Ep 28 · 1:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=60)
- "Probes are inserted via thoracoscopic port sites and activated at the site of intercostal nerves, usually bilaterally and within intercostal spaces three through seven" — Britney Hegdy (clinical) [Ep 28 · 1:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=60)
- "Cryo ablation subjects the intercostal nerves to extreme cold and is estimated to allow for pain control lasting weeks to months post ablation" — Britney Hegdy (clinical) [Ep 28 · 1:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=60)
- "Study included pediatric patients less than 18 from January 2011 to December 2021 who underwent minimally invasive repair" — Britney Hegdy (epidemiological) [Ep 28 · 3:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=180)
- "Cryo was introduced at the institution in November 2016 and every patient treated after this date received it" — Britney Hegdy (clinical) [Ep 28 · 3:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=180)
- "Of the 44 patients included, 29 (65.9%) received cryo during minimally invasive repair" — Britney Hegdy (epidemiological) [Ep 28 · 4:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=240)
- "A greater percentage in both treatment groups were male" — Britney Hegdy (epidemiological) [Ep 28 · 4:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=240)
- "Both treatment groups were similar regarding age, height, weight, insurance status, race, symptoms at presentation and Haller index" — Britney Hegdy (epidemiological) [Ep 28 · 4:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=240)
- "Bayesian models were used to analyze the impact of cryo on various outcomes utilizing a neutral prior assuming no treatment effect" — Britney Hegdy (clinical) [Ep 28 · 5:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=300)
- "Cryo use was associated with an 89% probability of total hospital cost reduction compared to no cryo use with a difference in total cost of $880" — Britney Hegdy (clinical) [Ep 28 · 5:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=300)
- "The decrease in total cost is likely attributable to the impact of cryo use on hospital days" — Britney Hegdy (opinion) [Ep 28 · 5:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=300)
- "Cryo use was associated with a 100% probability of reduction in index hospital days compared to no cryo use" — Britney Hegdy (clinical) [Ep 28 · 5:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=300)
- "When comparing total hospital days including readmissions during 90 days, there was a 99% probability of total hospital days reduction with the use of cryo" — Britney Hegdy (clinical) [Ep 28 · 5:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=300)
- "The incidence of post-operative complications did not differ between treatment groups" — Britney Hegdy (clinical) [Ep 28 · 6:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=360)
- "Cryo use was associated with a 70% probability of reduction in post-operative complications compared to no cryo use" — Britney Hegdy (clinical) [Ep 28 · 6:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=360)
- "Total hospital cost data was adjusted for inflation by the consumer price index for medical services" — Britney Hegdy (clinical) [Ep 28 · 3:00](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-brittany-hegde-paps-presentation-6359?t=180)
- "Pectus excavatum is the most common chest wall deformity, though Argentina reports carinatum as more common in their country." (epidemiological) [Ep 1 · 2:19](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=139)
- "Pectus excavatum is rarely seen in African Americans." (epidemiological) [Ep 1 · 2:31](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=151)
- "Pectus excavatum is more often in males than females and statistically appears more common in tall, thin white boys." (epidemiological) [Ep 1 · 2:57](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=177)
- "Females with pectus have a slightly increased risk of mild scoliosis, occurring in 18% of those with pectus." (epidemiological) [Ep 1 · 3:11](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=191)
- "Many patients with pectus have a connective tissue disorder higher than in the normal population, such as Marfan syndrome and Ehlers-Danlos syndrome." (clinical) [Ep 1 · 3:26](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=206)
- "Studies show varying degrees of cardiac and pulmonary compromise in pectus excavatum, which seems to worsen as patients grow and their chest wall becomes less compliant." (clinical) [Ep 1 · 4:08](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=248)
- "Patients with deep pectus defects can have decreased cardiac output due to heart displacement, causing them to tire quicker than peers during exercise." (clinical) [Ep 1 · 4:22](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=262)
- "Pulmonary effects can include restrictive lung disease pattern and atelectasis if the chest is sufficiently restricted." (clinical) [Ep 1 · 4:43](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=283)
- "In Maryland, insurance typically covers pectus repair if the Haller index (pectus index) is greater than 3.25." (guideline) [Ep 1 · 5:12](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=312)
- "Johns Hopkins developed a pectus excavatum CT protocol using a flash scan with fewer cuts at deeper depth to reduce radiation exposure." (clinical) [Ep 1 · 6:17](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=377)
- "PA and lateral chest X-ray can be used to accurately measure pectus severity index without CT scan." (clinical) [Ep 1 · 6:58](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=418)
- "Some patients with severe psychological symptoms from pectus may not be satisfied with surgical outcomes even when the chest result is objectively good." (opinion) [Ep 1 · 8:50](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=530)
- "Dr. Nuss from King's Daughters Children's Hospital in Virginia began the minimally invasive pectus repair operation in 1988, placing a stainless steel rod underneath the chest wall." (clinical) [Ep 1 · 11:36](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=696)
- "The Nuss bar is usually kept in place for 2 to 3 years." (clinical) [Ep 1 · 12:24](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=744)
- "At Johns Hopkins, bars are left in closer to 3 years because longer duration decreases recurrence rate, especially in younger patients who may have significant growth spurts." (clinical) [Ep 1 · 12:37](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=757)
- "The average age for pectus excavatum surgery is about 14 years." (clinical) [Ep 1 · 12:56](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=776)
- "Vacuum bell therapy involves wearing a device for several hours a day to pull up the sternum, likely requiring a younger patient with compliant chest wall." (clinical) [Ep 1 · 13:42](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=822)
- "Dr. Nuss and colleagues in Virginia use the vacuum bell intraoperatively to elevate deep pectus defects and facilitate safer bar passage." (clinical) [Ep 1 · 14:23](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=863)
- "UCSF and Shriners are conducting the Magnetic Mini Mover trial for pectus excavatum in 8-14 year olds, using internal and external magnets to create a force field over several months to elevate the chest." (clinical) [Ep 1 · 15:48](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=948)
- "Diana Farmer reported that the magnetic therapy is quite effective based on preliminary results." (host_summary) [Ep 1 · 17:01](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1021)
- "At Johns Hopkins, combined cardiac and pectus repair is performed simultaneously by pediatric and cardiac surgeons in patients with Marfan syndrome and cardiac issues, avoiding two separate surgeries." (clinical) [Ep 1 · 18:28](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1108)
- "Pectus carinatum patients may complain of tenderness at the protrusion, especially if they play sports with pads or sleep on their stomach." (clinical) [Ep 1 · 19:34](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1174)
- "Bracing has become the standard of care for pectus carinatum, with minimal postoperative problems and rare recurrence when surgery is performed." (clinical) [Ep 1 · 20:02](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1202)
- "Pectus carinatum braces are typically worn 23 hours a day initially, then weaned to nighttime only, for about 9-12 months total." (clinical) [Ep 1 · 21:52](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1312)
- "The dynamic compression device from Argentina (Marcelo Martinez Ferro's brace) is emerging as the best brace for pectus carinatum, with pressure measurement and time sensing capabilities." (opinion) [Ep 1 · 23:04](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1384)
- "Physical therapist application of pectus carinatum braces, with chest massage and manual defect reduction before tightening, results in better compliance and outcomes compared to orthotist application." (clinical) [Ep 1 · 25:45](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1545)
- "The Abramson technique (reverse Nuss) for pectus carinatum places a bar over the sternum, but wire erosion through bone has been reported due to the compressive force." (clinical) [Ep 1 · 26:35](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1595)
- "Poland syndrome patients with underdeveloped fingers or syndactyly are referred to plastic surgery at a young age for early intervention." (clinical) [Ep 1 · 29:18](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1758)
- "For Poland syndrome chest wall reconstruction, plastic surgery waits until patients are nearly done growing and uses flap techniques similar to post-mastectomy reconstruction." (clinical) [Ep 1 · 29:41](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1781)
- "Pain from the Nuss repair is reportedly greater than the Ravitch repair despite smaller incisions." (clinical) [Ep 1 · 31:17](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1877)
- "At Johns Hopkins, PCA provides better pain control than epidurals for pectus patients, and epidurals delayed early ambulation." (clinical) [Ep 1 · 31:39](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1899)
- "Pectus excavatum patients at Johns Hopkins do not receive Foley catheters and ambulate to the bathroom the night of surgery." (clinical) [Ep 1 · 32:00](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1920)
- "Typical hospital discharge after Nuss procedure is by postoperative day 3 or 4." (clinical) [Ep 1 · 32:33](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1953)
- "Patients are transitioned from PCA to oral oxycodone the day after surgery if eating well." (clinical) [Ep 1 · 32:52](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1972)
- "Haller index greater than 3.25 is the threshold for insurance coverage of pectus repair at Johns Hopkins." (guideline) [Ep 1 · 35:19](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=2119)
- "Patients in better physical condition who play sports and do upper body work recover faster from pectus surgery." (clinical) [Ep 1 · 36:11](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=2171)
- "The Nuss procedure typically takes about one hour of operative time." (clinical) [Ep 1 · 36:48](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=2208)
- "Intraoperative antibiotics are given but not continued postoperatively for pectus repair." (clinical) [Ep 1 · 37:07](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=2227)
- "Patients are allowed to position themselves however comfortable after Nuss repair, with no strict positioning restrictions." (clinical) [Ep 1 · 37:16](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=2236)
- "Activity restrictions after Nuss repair include no heavy lifting greater than 10 pounds for 6 weeks and no contact sports during that period." (clinical) [Ep 1 · 39:05](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=2345)
- "Valium is added to oxycodone for postoperative pain management to help with anxiety and muscle spasms in the back from posture changes." (clinical) [Ep 1 · 39:39](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=2379)
- "Most pectus patients are off narcotic pain medication between 2 and 4 weeks postoperatively." (clinical) [Ep 1 · 42:20](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=2540)
- "Compliance rate with pectus carinatum bracing is approximately 85%." (clinical) [Ep 1 · 45:12](https://qa.library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=2712)
- "Haller index threshold of 3.25 originated from a retrospective study by Alec Haller in the 1980s comparing cases he fixed versus those he did not fix" (clinical) [Ep 9 · 4:24](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=264)
- "The Haller index study was not an earth-shattering study at the time but has been used consistently for 30 years" (opinion) [Ep 9 · 4:55](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=295)
- "Psychosocial aspects of growing up are very important, and severe deformities should be fixed for psychosocial well-being regardless of physical symptoms" (opinion) [Ep 9 · 1:50](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=110)
- "Insurance companies require documented symptoms and Haller index for approval of pectus repair" (guideline) [Ep 9 · 2:07](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=127)
- "Nickel allergy frequency in pectus patients is 2.8% (almost 3%) based on Nuss group data from 1200 patients" (host_summary) [Ep 9 · 24:10](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1450)
- "In a randomized trial of 110 patients, epidural catheters were removed within 24 hours or could not be placed in almost 25% of patients despite experienced anesthesiologists" (host_summary) [Ep 9 · 18:09](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1089)
- "Epidural group had longer OR time due to catheter placement, more phone calls to anesthesia, and greater hospital charges compared to PCA" (host_summary) [Ep 9 · 17:35](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1055)
- "Pain scores generally favored epidural for the first 2 days, were flat on day 3, and favored PCA for the last couple of days" (host_summary) [Ep 9 · 17:55](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1075)
- "In Kansas City series of 168 patients over 6 years, there were 6 infections (3.6%), 5 required incision and drainage, 3 developed recurrent infections, and 1 required early bar removal" (epidemiological) [Ep 9 · 19:47](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1187)
- "Nuss group data from 1200 patients showed better results when bars were left in at least 24 months, with Dr. Nuss recommending 3 years" (host_summary) [Ep 9 · 24:26](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1466)
- "Kansas City series of 300 pectus excavatum repairs using subxiphoid technique: 5% required two bars, 4% infection rate, 1.5% bar dislodgement or stabilizer discomfort, 4 patients had bar rotation (early experience), 2 patients required chest tube, no recurrences requiring reoperation, no cardiac injuries, mean hospitalization 4 days" (epidemiological) [Ep 9 · 25:27](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1527)
- "There are approximately 14-15 reported cases of cardiac injury with the Nuss procedure worldwide" (epidemiological) [Ep 9 · 11:04](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=664)
- "The subxiphoid incision technique allows finger guidance of the bar across the mediastinum above the heart, which the Kansas City group considers the safest way to avoid cardiac injury" (clinical) [Ep 9 · 13:59](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=839)
- "Thoracoscopy is not that helpful for cardiac injury prevention according to Kansas City experience, though most surgeons worldwide outside Kansas City use thoracoscopy" (opinion) [Ep 9 · 13:07](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=787)
- "Transesophageal echo can identify adhesions between heart and sternum, particularly useful in redo cases where cardiac injury risk is higher from tethering" (clinical) [Ep 9 · 15:21](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=921)
- "Dynamic compression bracing for pectus carinatum is effective when correction requires less than 7.5 PSI pressure" (clinical) [Ep 9 · 30:08](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1808)
- "Kansas City has braced 200 pectus carinatum patients with dynamic compression bracing and has performed only one or two open repairs in the past 4 years" (epidemiological) [Ep 9 · 33:08](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1988)
- "Brace wearing is recommended for 6-20 months followed by retainer mode (6-12 hours daily)" (clinical) [Ep 9 · 30:44](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1844)
- "The dynamic compression brace costs approximately $1500-2000 total (kit plus device), billed through the hospital to insurance" (clinical) [Ep 9 · 33:40](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=2020)
- "Magnetic mini-mover procedure (3MP) is in FDA trial, 18 months into enrollment with all patients implanted, requiring another 18 months of data collection" (host_summary) [Ep 9 · 28:21](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1701)
- "Currarino-Silverman syndrome shows a characteristic comma deformity on lateral X-ray and requires open Ravitch-type repair" (clinical) [Ep 9 · 31:02](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1862)
- "Cincinnati Children's uses functional cardiac MRI to assess contractility, shift, and cardiac impact from pectus deformities, along with other scoring indices beyond Haller" — Todd Ponsky (host_summary) [Ep 9 · 3:36](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=216)
- "Some severely deformed chests have normal Haller scores due to combined anterior-posterior discrepancies" (clinical) [Ep 9 · 4:09](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=249)
- "Rarely do pectus patients have documented palpitations or clear evidence they are not keeping up with peers in terms of cardiac output" (opinion) [Ep 9 · 2:35](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=155)
- "Some pectus patients have real costochondral pain that can be a surgical indication" (clinical) [Ep 9 · 2:59](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=179)
- "Cardiorespiratory symptoms in pectus patients remain debatable regarding clinical significance despite careers spent trying to prove their importance" (opinion) [Ep 9 · 3:07](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=187)
- "Pulmonology and cardiology consults are obtained when patients have symptoms without significant pectus deformity to rule out reactive airway disease or other cardiac issues unrelated to pectus" (clinical) [Ep 9 · 5:41](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=341)
- "Documentation of symptom relief related to surgery is important for insurance purposes, requiring workup even though consults typically return normal except for anatomical findings" (clinical) [Ep 9 · 5:54](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=354)
- "A bone hook through the subxiphoid incision can lift the sternum to gain an additional 1-2 millimeters of space for bar passage in very deep deformities" (clinical) [Ep 9 · 15:45](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=945)
- "A suction valve device in Germany is placed on the chest to lift it and facilitate bar passage, but is not approved in the United States" (clinical) [Ep 9 · 16:19](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=979)
- "Rib flaring occurs postoperatively, sometimes bilaterally or unilaterally, and most surgeons do nothing about it" (clinical) [Ep 9 · 20:34](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1234)
- "When bars are removed at 3 years, families generally do not want rib flaring addressed because the pectus looks good and rib flaring is not as bad as the original deformity" (clinical) [Ep 9 · 23:14](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1394)
- "Dr. Abramson in Buenos Aires has devised a minimally invasive operation for pectus carinatum with published 5-year experience" (host_summary) [Ep 9 · 31:44](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1904)
- "Norfolk colleagues published on staged management of pectus carinatum including bracing and the Abramson procedure" (host_summary) [Ep 9 · 32:07](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1927)
- "Passing the bar left to right (rather than right to left) may be safer because once past the heart on the left, the right side has less cardiac risk" (opinion) [Ep 9 · 12:20](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=740)
- "In deep pectus cases, thoracoscopy shows the heart where the bar crosses over it, making the right side less risky than the left" (clinical) [Ep 9 · 12:41](https://qa.library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=761)
- "Rebecca Garcia underwent pectus repair surgery on August 1st of the previous year at age 21" — Rebecca Garcia (clinical) [Ep 12 · 0:15](https://qa.library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=15)
- "Rebecca had previously undergone the Ravitch procedure in Atlanta, Georgia at age 3 or 4 years old" — Rebecca Garcia (clinical) [Ep 12 · 0:22](https://qa.library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=22)
- "Despite prior Ravitch procedure, Rebecca continued to experience chest pains and trouble breathing" — Rebecca Garcia (clinical) [Ep 12 · 0:22](https://qa.library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=22)
- "Meditation, specifically Jack Kornfield videos recommended by Dr. Garcia, helped with mental recovery from pectus surgery" — Rebecca Garcia (opinion) [Ep 12 · 1:39](https://qa.library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=99)
- "Post-operative pectus patients experience significant physical restrictions including inability to turn, twist, or lift more than 5 pounds" — Rebecca Garcia (clinical) [Ep 12 · 2:19](https://qa.library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=139)
- "The mental and emotional burden of post-operative dependency is as significant as the physical recovery challenges" — Rebecca Garcia (opinion) [Ep 12 · 2:19](https://qa.library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=139)
- "Robaxin (methocarbamol) helps relieve chest tightness and pressure sensations in post-operative pectus patients" — Rebecca Garcia (clinical) [Ep 12 · 3:36](https://qa.library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=216)
- "Dr. Garcia required Rebecca to wait 3 months before returning to weight training after pectus repair" — Rebecca Garcia (clinical) [Ep 12 · 4:15](https://qa.library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=255)
- "After 3 months and gradual return to exercise, Rebecca achieved strength levels exceeding her pre-operative baseline" — Rebecca Garcia (clinical) [Ep 12 · 4:32](https://qa.library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=272)
- "Having a dedicated pain team with established protocols reduces delays in pain medication administration" — Todd Ponsky (opinion) [Ep 12 · 5:41](https://qa.library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=341)
- "Pain team protocols eliminate the need to wait for individual physician orders for pain medication" — Todd Ponsky (clinical) [Ep 12 · 5:41](https://qa.library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=341)
- "Patients are systematically screened for resistant staph (MRSA/URSA) prior to pectus surgery" — Garcia (clinical) [Ep 12 · 7:23](https://qa.library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=443)
- "Patients who screen positive for resistant staph receive nasal and underarm swabs and are prepared according to protocol" — Garcia (clinical) [Ep 12 · 7:29](https://qa.library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=449)
- "Bactroban is given intranasally twice per day for 7 days prior to surgery for patients with resistant staph colonization" (clinical) [Ep 12 · 7:40](https://qa.library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=460)
- "Vacuum belts for pectus patients are obtained directly from suppliers in Germany at a cost of approximately $400-500" (clinical) [Ep 12 · 8:11](https://qa.library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=491)
- "For routine procedures like umbilical hernia repair, one surgeon places no activity restrictions, relying on children's self-limitation based on pain" (clinical) [Ep 12 · 8:40](https://qa.library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=520)
- "For pectus patients, full activity is permitted after 3 months (12 weeks) post-operatively" (clinical) [Ep 12 · 9:16](https://qa.library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=556)
- "Adolescent pectus patients do not always adhere to the 3-month activity restriction, with some observed doing prohibited activities" (clinical) [Ep 12 · 9:43](https://qa.library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=583)
- "After 3 months, pectus patients are recommended to perform stretching and core strengthening exercises using instructional YouTube videos" (clinical) [Ep 12 · 9:54](https://qa.library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=594)
- "A good percentage of lower anterior rib flaring after Nuss procedure resolves spontaneously" (clinical) [Ep 12 · 10:45](https://qa.library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=645)
- "For older patients with rib flaring, ribs below the repair site can be broken and pushed down, a technique observed at Mayo Clinic" (clinical) [Ep 12 · 10:50](https://qa.library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=650)
- "Rib osteotomy for flaring is less effective in pediatric patients due to their greater flexibility" (clinical) [Ep 12 · 11:04](https://qa.library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=664)
- "Rib flaring tends to improve over time in many pediatric pectus patients" — Garcia (clinical) [Ep 12 · 11:13](https://qa.library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=673)
- "Sleeping position after pectus repair is patient-guided; if side-sleeping is comfortable, it is permitted" (clinical) [Ep 12 · 11:33](https://qa.library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=693)
- "Patients naturally move during sleep regardless of prescribed sleeping positions" (clinical) [Ep 12 · 11:54](https://qa.library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=714)
- "MRI is preferred over CT scan for pectus evaluation based on discussion during this session" — Todd Ponsky (host_summary) [Ep 12 · 12:40](https://qa.library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=760)
- "Cardiac effects of pectus excavatum are clinically significant, not merely cosmetic" — Todd Ponsky (host_summary) [Ep 12 · 12:35](https://qa.library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=755)
- "A planned study will examine post-operative cardiac findings in pectus patients, led by cardiologist Michael Taylor" (clinical) [Ep 12 · 13:19](https://qa.library.globalcastmd.com/watch/patient-testimonial-and-experience-pectus-innovations-1014?t=799)
- "Older pectus patients report progressive exercise intolerance and breathing difficulty developing over the last decade after being asymptomatic their whole life." — Dawn (clinical) [Ep 15 · 0:00](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=0)
- "99% of pectus patients have transthoracic echocardiograms reported as normal with no issues." — Dawn (clinical) [Ep 15 · 1:24](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=84)
- "Transthoracic echo has difficulty obtaining adequate windows to visualize the right side of the heart in pectus patients." — Dawn (clinical) [Ep 15 · 1:32](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=92)
- "Intraoperative transesophageal echocardiography shows marked improvement in right ventricular chamber dimensions after pectus repair." — Dawn (clinical) [Ep 15 · 1:46](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=106)
- "Flow velocity through the right ventricular outflow tract nearly triples after pectus repair." — Dawn (clinical) [Ep 15 · 2:08](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=128)
- "Left ventricular output significantly improves when right ventricular flow increases after pectus repair because the heart functions as a pump." — Dawn (clinical) [Ep 15 · 2:25](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=145)
- "Cardiac output can improve from 55% (normal range) to 77% after pectus repair in older patients, with patients noticing improved exercise capacity and reduced fatigue." — Dawn (clinical) [Ep 15 · 2:59](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=179)
- "Cardiac contractility, synchrony, and mobility show significant differences between pre-operative and post-operative states in pectus patients." — Dawn (clinical) [Ep 15 · 3:26](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=206)
- "The efficiency of the cardiac pump improves after pectus repair, likely due to correction of heart distortion and right ventricular chamber deflection." — Dawn (clinical) [Ep 15 · 3:42](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=222)
- "In a series of 168 patients, minimally invasive repair (MIRP) showed 30% increase in cardiac output while open repair showed less improvement, possibly because open cases include mixed pathology like malunion." — Dawn (clinical) [Ep 15 · 3:57](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=237)
- "Overall cardiac output increased 24% across all pectus repair patients in the series." — Dawn (clinical) [Ep 15 · 4:24](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=264)
- "Pectus excavatum is a medical disease, not cosmetic, and affects patients physiologically, with worsening tolerance to compression as they age." — Dawn (opinion) [Ep 15 · 4:28](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=268)
- "Standard Bruce protocol ischemic stress testing is not appropriate for pectus evaluation unless ischemia is suspected; cardiopulmonary exercise testing is needed instead." — Dawn (clinical) [Ep 15 · 4:53](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=293)
- "Cardiopulmonary exercise testing evaluates VO2 max and anaerobic VO2, which are very abnormal in pectus patients while other parameters remain normal, and separates cardiac from pulmonary components." — Dawn (clinical) [Ep 15 · 5:27](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=327)
- "A French study of 125 adults showed cardiopulmonary exercise parameters statistically improve and normalize after surgical pectus repair." — Dawn (epidemiological) [Ep 15 · 5:49](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=349)
- "Pectus patients show limited ability to increase stroke volume during exercise; output initially increases by heart rate but plateaus when volume increase is needed due to chest cage restriction, appearing as a flat line rather than the normal upward slope." — Dawn (clinical) [Ep 15 · 6:02](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=362)
- "The flat stroke volume response to exercise improves statistically significantly after pectus repair." — Dawn (clinical) [Ep 15 · 6:25](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=385)
- "Cardiopulmonary exercise testing is used routinely in congenital heart disease to assess functional capacity and guide decisions about palliation and conduit replacement." — Michael (clinical) [Ep 15 · 7:04](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=424)
- "Cardiopulmonary exercise testing has not been performed frequently for pectus patients because surgical decisions have been made on other bases and testing has not been required." — Michael (clinical) [Ep 15 · 7:10](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=430)
- "Cardiopulmonary exercise testing would be a good tool for borderline pectus cases where there is uncertainty about proceeding with surgery." — Michael (opinion) [Ep 15 · 7:44](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=464)
- "Ehlers-Danlos type 4 (vascular type) does not typically present with pectus excavatum as it is not primarily a skeletal or hypermobile disorder." (clinical) [Ep 15 · 9:03](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=543)
- "Ehlers-Danlos type 4 involves internal tissue fragility requiring specially managed repairs, and would require careful consideration before proceeding with pectus surgery." (clinical) [Ep 15 · 9:21](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=561)
- "Genetic testing should be performed to confirm Ehlers-Danlos type 4, and skin biopsy may be needed if genetic testing is normal but clinical suspicion remains high." (clinical) [Ep 15 · 9:38](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=578)
- "Patients frequently self-diagnose Ehlers-Danlos vascular type based on internet research, visible veins, or family history of abdominal aortic aneurysm, none of which actually indicate the disorder." (clinical) [Ep 15 · 9:50](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=590)
- "There is no genetic disorder that represents an absolute contraindication to pectus surgery, only relative contraindications based on functional status." (opinion) [Ep 15 · 10:52](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=652)
- "Very young children may outgrow their pectus bars and require explantation and replacement, representing a cost of early repair." — Dawn (clinical) [Ep 15 · 11:25](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=685)
- "Adolescents who are nearly completely grown may have better cost-benefit ratio for pectus repair compared to very young children." — Dawn (opinion) [Ep 15 · 11:25](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=685)
- "A seven-year-old with severe symptomatic pectus may need earlier repair despite general preference to wait." — Dawn (opinion) [Ep 15 · 11:53](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=713)
- "An Easter Seals grant study at UCLA using cardiopulmonary exercise testing in children showed that while some classes of patients had deficits, a large percentage of children did not show problems." — Dawn (epidemiological) [Ep 15 · 12:08](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=728)
- "Compensation mechanisms work better in younger pectus patients; deficits become more apparent on testing as patients age." — Dawn (clinical) [Ep 15 · 12:34](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=754)
- "Some children are completely asymptomatic and progress to become symptomatic as they age, while others are symptomatic when very young." — Dawn (clinical) [Ep 15 · 12:44](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=764)
- "Pectus operations are better tolerated when patients are younger, but older patients require substantial narcotics for pain control." (host_summary) [Ep 15 · 13:36](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=816)
- "Young children have more pliable chest walls, allowing repair with minimal force (described as 'a popsicle stick'), while adults have tremendous pain due to chest wall rigidity." — Dawn (clinical) [Ep 15 · 14:51](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=891)
- "In Korea, pectus repairs are performed on 3-4-5 year olds using very small bar sets." — Dawn (clinical) [Ep 15 · 15:06](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=906)
- "The trend in the United States has shifted from repairing pectus patients young to repairing them at older ages." — Dawn (epidemiological) [Ep 15 · 15:18](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=918)
- "Donald Nuss initially performed pectus repairs on very young patients, as young as 3 years of age, without high recurrence rates in his early series." (host_summary) [Ep 15 · 15:41](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=941)
- "The institution where Donald Nuss practices has moved away from performing pectus repairs on young children, suggesting they encountered more issues than reported in initial series, possibly identified during long-term follow-up." — Dawn (clinical) [Ep 15 · 16:37](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=997)
- "Korean surgeons (specifically Yung Park) routinely repair pectus in young children and report no problems, considering it unusual to wait until older ages." — Dawn (clinical) [Ep 15 · 16:57](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=1017)
- "Vacuum bell therapy works if the patient has a very flexible chest and wears the device religiously." — Dawn (clinical) [Ep 15 · 17:45](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=1065)
- "Patient compliance with vacuum bell therapy varies greatly, with many young children tolerating it for only short periods despite parental efforts." — Dawn (clinical) [Ep 15 · 17:57](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=1077)
- "Vacuum bell therapy is recommended for very young children (e.g., 5 years old) as an alternative to operative repair." — Dawn (opinion) [Ep 15 · 18:27](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=1107)
- "Dawn has selection bias in her practice because she predominantly sees symptomatic pectus patients, while thousands of asymptomatic adults with pectus likely exist." — Dawn (opinion) [Ep 15 · 19:39](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=1179)
- "95% of patients presenting to Dawn's office are seeking surgery." — Dawn (epidemiological) [Ep 15 · 20:25](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=1225)
- "When discussing testing results with pectus patients, they often reveal subtle symptoms they had not previously recognized or reported, such as reduced exercise capacity compared to peers." — Dawn (clinical) [Ep 15 · 20:32](https://qa.library.globalcastmd.com/watch/physiology-pectus-innovations-1017?t=1232)
- "In pectus excavatum clinics, genetic evaluation primarily screens for Marfan syndrome and Ehlers-Danlos syndrome." (clinical) [Ep 16 · 0:00](https://qa.library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=0)
- "Marfan syndrome skeletal evaluation includes the wrist sign (thumb and pinky finger overlap when wrapped around wrist) and thumb protrusion past the ulnar border, assessing for long bone overgrowth relative to trunk." (clinical) [Ep 16 · 0:21](https://qa.library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=21)
- "Marfan syndrome skeletal findings include evaluation of arm span to height ratios and upper to lower segment ratios." (clinical) [Ep 16 · 1:00](https://qa.library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=60)
- "Additional Marfan skeletal findings include pectus excavatum, pectus carinatum, scoliosis, and hind foot deformities." (clinical) [Ep 16 · 1:07](https://qa.library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=67)
- "Marfan syndrome screening is motivated by cardiac risk (aortic dissection) and other complications including mitral valve prolapse and retinal detachments." (clinical) [Ep 16 · 1:19](https://qa.library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=79)
- "Marfan syndrome diagnosis now centers on cardiac findings, with echocardiogram or MRI as main tools to evaluate for dilated aortic root." (clinical) [Ep 16 · 1:38](https://qa.library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=98)
- "Marfan evaluation includes assessment for lens dislocations, and in suggestive cases, genetic testing of the fibrillin gene." (clinical) [Ep 16 · 1:55](https://qa.library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=115)
- "Patients with Marfan-like characteristics may warrant extended genetic evaluation for other syndromes involving TGF beta signaling, which contributes to aortic remodeling and long bone overgrowth." (clinical) [Ep 16 · 2:05](https://qa.library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=125)
- "Ehlers-Danlos syndrome is by far the more common condition evaluated in pectus clinics compared to Marfan syndrome." (epidemiological) [Ep 16 · 2:27](https://qa.library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=147)
- "Ehlers-Danlos syndrome represents a grouping of related connective tissue conditions, not a single entity." (clinical) [Ep 16 · 2:45](https://qa.library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=165)
- "Classic Ehlers-Danlos is caused by defects in collagen 5 and characterized by joint hypermobility and abnormal skin that is fragile, thin, with weak papery scars." (clinical) [Ep 16 · 3:00](https://qa.library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=180)
- "Vascular Ehlers-Danlos is caused by mutations in collagen 3 and involves internal organ fragility rather than primarily hypermobile joints." (clinical) [Ep 16 · 3:17](https://qa.library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=197)
- "Vascular Ehlers-Danlos screening focuses on family or personal history of ruptures (bowel, aortic, or uterine rupture)." (clinical) [Ep 16 · 3:52](https://qa.library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=232)
- "Vascular Ehlers-Danlos has genetic testing that is 99% sensitive." (clinical) [Ep 16 · 4:07](https://qa.library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=247)
- "Vascular Ehlers-Danlos is one of the least common conditions seen in pectus clinics." (epidemiological) [Ep 16 · 3:39](https://qa.library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=219)
- "Hypermobile Ehlers-Danlos is the type typically evaluated in pectus clinics, characterized by very flexible patients." (clinical) [Ep 16 · 4:23](https://qa.library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=263)
- "The Beighton score is a formal test of 9 different joints, scored 1 point for each side except the hips, used to assess hypermobility." (clinical) [Ep 16 · 4:41](https://qa.library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=281)
- "Beighton score criteria include: arm hyperextension past 10 degrees, pinky hyperextension past 90 degrees, thumb apposition to forearm, knee hyperextension past 10 degrees (all bilateral, 8 points total), and placing hands flat on floor without bending knees (assessing hip hypermobility)." (clinical) [Ep 16 · 4:52](https://qa.library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=292)
- "A Beighton score of 5 or more hypermobile joints meets criteria for generalized hypermobility." (clinical) [Ep 16 · 5:27](https://qa.library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=327)
- "Additional hypermobile Ehlers-Danlos findings include mild skin changes (mildly hyperextensible, easy bruising, scarring abnormalities, striae) and family history of hypermobility." (clinical) [Ep 16 · 5:35](https://qa.library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=335)
- "The dividing line between being flexible and having Ehlers-Danlos may be very fuzzy; diagnosis requires similar findings in family members and presence of clinical problems." (clinical) [Ep 16 · 6:01](https://qa.library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=361)
- "Hypermobile Ehlers-Danlos patients exhibit a constellation of findings: chronic pain, chronic headaches/migraines, TMJ dysfunction, easy bruising/bleeding, orthostatic hypotension/dizziness/blacking out with standing, episodes of racing heartbeat, chronic constipation with IBS, panic and anxiety disorders, and sleeping problems." (clinical) [Ep 16 · 6:32](https://qa.library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=392)
- "Most adult hypermobile Ehlers-Danlos patients presenting to clinic have almost all of the associated constellation of problems." (epidemiological) [Ep 16 · 7:12](https://qa.library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=432)
- "In children with hypermobile Ehlers-Danlos, problems may be very mild or not evident initially, but may emerge during puberty, which may coincide with consideration of pectus surgery." (clinical) [Ep 16 · 7:17](https://qa.library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=437)
- "The chronic pain aspect of hypermobile Ehlers-Danlos can influence risk for more pain from pectus surgery." (clinical) [Ep 16 · 7:33](https://qa.library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=453)
- "Hypermobility is a risk factor for fibromyalgia; 50% of teenagers diagnosed with fibromyalgia have hypermobility." (epidemiological) [Ep 16 · 7:42](https://qa.library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=462)
- "Fibromyalgia involves central sensitivity to pain, meaning patients are unable to filter out unwanted pain signals in the same way as other persons." (clinical) [Ep 16 · 7:56](https://qa.library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=476)
- "Hypermobile patients may be at risk for more problems with chronic pain due to central pain sensitivity mechanisms." (clinical) [Ep 16 · 8:08](https://qa.library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=488)
- "One clinician's screening approach for pectus patients includes checking for double-jointedness, Marfan appearance (arachnodactyly), and striae, with genetics referral if findings are present." (clinical) [Ep 16 · 8:41](https://qa.library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=521)
- "Nothing is as good as epidural analgesia for pectus patients; On-Q pumps come second to epidural." — Centel Sadai (opinion) [Ep 13 · 0:29](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=29)
- "Seattle Children's Hospital has gone from epidural to On-Q pump recently and is having some issues." — Centel Sadai (host_summary) [Ep 13 · 0:45](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=45)
- "More than 95% of Cincinnati's pectus patients do not get a PCA along with epidural." — Centel Sadai (clinical) [Ep 13 · 1:28](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=88)
- "Older patients and young adults have more pain after pectus repair because of chest wall rigidity." — Centel Sadai (clinical) [Ep 13 · 2:24](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=144)
- "Patients with Ehlers-Danlos syndrome have extensive pain and often have pain even before surgery." — Centel Sadai (clinical) [Ep 13 · 2:35](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=155)
- "Recent literature shows that if a child and their parent have pain catastrophization (anticipating negative outcomes), they are more likely to have more pain after surgery." — Centel Sadai (host_summary) [Ep 13 · 3:29](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=209)
- "Most neurological risk with epidural in children is from hypoperfusion of spinal cord, not from traumatic placement." — Centel Sadai (clinical) [Ep 13 · 5:30](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=330)
- "On-Q pump outcomes depend on multiple factors: catheter size and length (5 cm too short, 7.5 cm better), introducer width (wider causes backflow leak), delivery rate, and location." — Don (clinical) [Ep 13 · 7:59](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=479)
- "Most On-Q data in thoracic surgery is from thoracotomy with subpleural tunneling, making it hard to extrapolate to pectus applications." — Don (opinion) [Ep 13 · 8:25](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=505)
- "Exparel (liposomal bupivacaine) is safer than plain local anesthetic because the treatment for local anesthetic toxicity is intralipid, and Exparel is already in intralipid." — Centel Sadai (clinical) [Ep 13 · 10:31](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=631)
- "In Cincinnati's donor nephrectomy experience with Exparel TAP blocks, patients go off PCA one day earlier, have less opioid-related adverse effects, and use less opioids." — Centel Sadai (clinical) [Ep 13 · 10:43](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=643)
- "Exparel is not approved for pediatric use by the FDA." — Centel Sadai (guideline) [Ep 13 · 10:52](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=652)
- "Some patients have localized reactions to Exparel impressive enough to require steroids, lasting 3 days." — Don (clinical) [Ep 13 · 11:23](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=683)
- "Cincinnati allows patients with epidurals to walk inside the room and outside with help; Foley catheters are removed the next day after surgery." — Centel Sadai (clinical) [Ep 13 · 12:05](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=725)
- "Cincinnati's surgical pain service sees patients minimum 3 times daily (morning, afternoon, evening rounds) and is available 24/7." — Centel Sadai (clinical) [Ep 13 · 14:12](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=852)
- "There is evidence in medical literature that meditation benefits include minimizing pain, anxiety, and improving immune function after surgery." — Centel Sadai (host_summary) [Ep 13 · 15:58](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=958)
- "About 20-30% of pectus patients experience chronic persistent post-operative pain, defined as pain score of 3 or more two months after surgery." — Centel Sadai (epidemiological) [Ep 13 · 18:00](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1080)
- "If a patient is on 5 days in a row of oxycodone or any other opioid, the risk of dependence goes up significantly." — Centel Sadai (clinical) [Ep 13 · 19:50](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1190)
- "A meta-analysis of 6 studies published last year found that compared to PCA, epidural provided better pain control the first 2 days after pectus repair." — Centel Sadai (host_summary) [Ep 13 · 21:42](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1302)
- "Two studies from Kansas with 22% and 35% epidural failure rates showed epidural didn't help relieve pain as well as PCA, likely due to poor epidural placement success." — Centel Sadai (host_summary) [Ep 13 · 22:19](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1339)
- "Cincinnati takes 10-15 minutes to place an epidural and achieves more than 95% success rate." — Centel Sadai (clinical) [Ep 13 · 23:13](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1393)
- "With a good working epidural, Cincinnati sees zero pain scores immediately after surgery in the first 2-3 days, which was unheard of 10-15 years ago." — Centel Sadai (clinical) [Ep 13 · 23:28](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1408)
- "Cincinnati uses local anesthetic-only epidural solution which does not cause urinary retention and is very dermatomal, blocking only thoracic dermatomes." — Centel Sadai (clinical) [Ep 13 · 23:46](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1426)
- "Most Cincinnati pectus patients go home on the 3rd or 4th day after surgery." — Centel Sadai (clinical) [Ep 13 · 24:18](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1458)
- "Cincinnati's epidural success rate is more than 95%, and the number of patients needing PCA on top of epidural is now less than 5% (was 14% in 2013)." — Centel Sadai (clinical) [Ep 13 · 25:02](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1502)
- "There is evidence that if you give pregabalin or gabapentin one hour before surgery, it decreases pain after surgery significantly and need for opioid is significantly less." — Centel Sadai (host_summary) [Ep 13 · 25:45](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1545)
- "Cincinnati uses IV methadone at lower doses (5 mg max) than adults (15-20 mg) because higher doses caused too much sedation in teenage pectus patients." — Centel Sadai (clinical) [Ep 13 · 27:10](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1630)
- "Methadone can cause prolongation of QT interval with reports of ventricular arrhythmias, so Cincinnati monitors with EKG to ensure QT doesn't exceed 480 milliseconds." — Centel Sadai (clinical) [Ep 13 · 28:19](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1699)
- "The number of Cincinnati patients needing any IV opioid in the first 2-3 days when they have epidural is less than 5%." — Centel Sadai (clinical) [Ep 13 · 28:47](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1727)
- "Cincinnati stops epidurals at 6 AM on post-op day 3 without weaning (from 8 mL/hour to zero immediately)." — Centel Sadai (clinical) [Ep 13 · 31:27](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1887)
- "The advantage of not using opioids in epidural solution is minimal; opioids cause more problems (itching, urinary retention) than benefit. Clonidine can provide the same pain relief without those side effects." — Centel Sadai (opinion) [Ep 13 · 31:56](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1916)
- "Cincinnati uses high concentration ropivacaine (0.2%) for epidural; lower concentrations (0.12% or 0.15%) don't provide adequate pain relief." — Centel Sadai (clinical) [Ep 13 · 32:22](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1942)
- "Mark Saxton reports that without routine Foley catheters, 1 in 7 pectus patients need to be catheterized for urinary retention." (host_summary) [Ep 13 · 34:14](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2054)
- "Naloxegol is a medication similar to naloxone that doesn't cross the blood-brain barrier, so it relieves opioid-induced constipation without reversing analgesia." — Centel Sadai (clinical) [Ep 13 · 35:21](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2121)
- "About 50% of Cincinnati's pectus patients get constipation the moment oxycodone is started." — Centel Sadai (epidemiological) [Ep 13 · 35:14](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2114)
- "In spine surgery patients (equally or less painful than pectus) who get PCA instead of epidural, about 15% have respiratory depression (respiratory rate <8, oxygen saturation <90%) despite multimodal analgesia." — Centel Sadai (clinical) [Ep 13 · 36:52](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2212)
- "There is evidence that if you use even one dose of methadone in the OR, it cuts back on opioid use significantly and improves pain control in the next two days." — Centel Sadai (host_summary) [Ep 13 · 41:13](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2473)
- "Thoracic surgery including pectus is considered high risk for persistent post-operative pain; about 20-30% of pectus patients develop chronic pain (pain score >3 at 2 months post-op)." — Centel Sadai (epidemiological) [Ep 13 · 41:43](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2503)
- "Children and young adults have higher risk of persistent post-operative pain than elderly patients." — Centel Sadai (host_summary) [Ep 13 · 42:08](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2528)
- "When pain is managed without regional anesthesia, the barrage of noxious stimuli to the brain precipitates neuroplasticity, causing the brain to remember pain long-term (6-12 months after surgery)." — Centel Sadai (clinical) [Ep 13 · 42:41](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2561)
- "Higher amounts of preoperative opioid use increase the risk for persistent pain; high opioid doses turn down opioid receptor genes, which is connected with persistent pain." — Centel Sadai (clinical) [Ep 13 · 43:17](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2597)
- "Seattle studies show that if a child doesn't sleep well before surgery (disturbed sleep, short duration), they are at high risk for persistent pain." — Centel Sadai (host_summary) [Ep 13 · 43:48](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2628)
- "Cincinnati performs preoperative CYP2D6 genetic testing; saliva or blood sample taken at surgical clinic, results available in EPIC within 2 days, covered by most insurance." — Centel Sadai (clinical) [Ep 13 · 44:26](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2666)
- "CYP2D6 is the major liver enzyme that metabolizes most oral opioids including codeine, tramadol, oxycodone, and hydrocodone." — Centel Sadai (clinical) [Ep 13 · 44:26](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2666)
- "There is evidence that codeine, tramadol, and hydrocodone are not safe in ultra-rapid metabolizers." — Centel Sadai (host_summary) [Ep 13 · 45:02](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2702)
- "Ultra-rapid metabolizers are not good candidates for codeine, tramadol, or hydrocodone, but they are okay with morphine and hydromorphone." — Centel Sadai (clinical) [Ep 13 · 45:44](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2744)
- "Cincinnati can reliably predict who will have respiratory depression by looking at their genes and genetic signature." — Centel Sadai (clinical) [Ep 13 · 48:27](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2907)
- "In Cincinnati population, only 1-2% are ultra-rapid metabolizers; in African American and especially Ethiopian populations, ultra-rapid metabolizers can be as high as 29%." — Centel Sadai (epidemiological) [Ep 13 · 49:38](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2978)
- "The FDA has warned against use of codeine following tonsillectomy; tramadol and hydrocodone warnings are under FDA review." — Centel Sadai (guideline) [Ep 13 · 50:00](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=3000)
- "Among currently available opioids, oxycodone is the least affected by CYP2D6 metabolism." — Centel Sadai (clinical) [Ep 13 · 50:13](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=3013)
- "Even extensive metabolizers (normal population) are at high risk for sedation and respiratory depression if they have coexisting morbidity like asthma or sleep apnea." — Centel Sadai (clinical) [Ep 13 · 51:01](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=3061)
- "Sedation always precedes respiratory depression; Cincinnati nurses monitor sedation using Ramsay sedation scale every shift to prevent respiratory depression." — Centel Sadai (clinical) [Ep 13 · 51:29](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=3089)
- "Cincinnati has not used naloxone for any pain patients in more than 3 years despite using maximum opioid amounts, attributed to aggressive monitoring." — Centel Sadai (clinical) [Ep 13 · 52:02](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=3122)
- "The 50-gene genetic panel costs $50; CYP2D6 testing costs less than $1 per gene." — Centel Sadai (clinical) [Ep 13 · 52:23](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=3143)
- "One gene (fatty acid amide hydrolase) associated with nausea, vomiting, and prolonged PACU stay saves more than $100 per patient when used to guide dosing, exceeding the cost of genotyping." — Centel Sadai (clinical) [Ep 13 · 52:42](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=3162)
- "Intercostal blocks are still good and better than nothing for preemptive pain control, but may miss one or two intercostal nerves and don't provide pain relief as good as epidural." — Centel Sadai (opinion) [Ep 13 · 53:23](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=3203)
- "Higher concentration of local anesthetic is better for preemptive analgesia, which is why Cincinnati places epidurals before surgery with high-concentration ropivacaine." — Centel Sadai (clinical) [Ep 13 · 53:44](https://qa.library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=3224)
- "True recurrence incidence after pectus repair is unknown because many patients don't report back to centers" — Don (epidemiological) [Ep 14 · 1:22](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=82)
- "In the original adult open repair series with Funkels at UCLA, reported recurrence rate was 5%, but over 10 years at least 20 patients from that series contacted for revision" — Don (epidemiological) [Ep 14 · 1:32](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=92)
- "Nuss procedure recurrences are related to technical issues: bar positioning, bar rotation, and pulling bars out too early" — Don (clinical) [Ep 14 · 2:12](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=132)
- "Open procedure recurrences involve different issues: healing problems, malunion, and regression itself is a very different beast" — Don (clinical) [Ep 14 · 2:22](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=142)
- "Once bars rotate, their ability to put pressure and elevate the chest wall is lost, and they usually cause pain" — Don (clinical) [Ep 14 · 3:14](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=194)
- "Lateral stripping is the most common problem seen in adult revisions - bar looks perfect on frontal X-ray but has stripped posteriorly on lateral view" — Don (clinical) [Ep 14 · 3:33](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=213)
- "Once a bar is not supported by the intercostal space and migrates posteriorly, there is no forward elevation and can cause cardiac obstruction or compression of lower structures" — Don (clinical) [Ep 14 · 3:58](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=238)
- "In adult population, chest is often so stiff and rigid that intercostal spaces can't support bar pressure, causing them to rip out and drop the bar in" — Don (clinical) [Ep 14 · 4:41](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=281)
- "About 30% of patients now receive 3 bars to balance the defect and distribute pressure" — Don (clinical) [Ep 14 · 7:47](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=467)
- "For very low bars, drill a hole through the sternum and pass suture to loop around sternum and bar in center to prevent rotation" — Don (clinical) [Ep 14 · 8:06](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=486)
- "Forced sternal elevation with Rultract makes dissection safer and easier by creating open space to work in" — Don (clinical) [Ep 14 · 6:19](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=379)
- "Initially used Rultract only on complicated cases, but now uses it on all cases for safety and ease" — Don (opinion) [Ep 14 · 6:36](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=396)
- "FiberWire (woven PTFE suture) used in figure-of-eight around ribs and bar prevents ribs from separating and bar from dropping in" — Don (clinical) [Ep 14 · 6:53](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=413)
- "Single bar in center of defect is not enough for heavier, stiffer chests - causes tremendous pain and risk of movement and stripping" — Don (clinical) [Ep 14 · 7:22](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=442)
- "Optimal bar length is 2-3 centimeters overlapped, catching side ribs but not wrapping all the way around to the back" — Don (clinical) [Ep 14 · 15:59](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=959)
- "In younger adults under 30, almost all patients could be lifted with Rultract and Lorenz dissector, with only a couple exceptions" — Don (epidemiological) [Ep 14 · 19:02](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=1142)
- "In adults over 30, approximately 88.7% could be lifted with forced elevation, but 11-12% would not lift" — Don (epidemiological) [Ep 14 · 19:20](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=1160)
- "If chest doesn't lift initially, bars alone will not make it lift eventually - they're not strong enough" — Don (clinical) [Ep 14 · 20:22](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=1222)
- "Releasing osteotomy technique involves cutting cartilages from sternum at the site that won't lift, then shortening cartilages to allow them to come back down" — Don (clinical) [Ep 14 · 20:55](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=1255)
- "Sometimes only one or two sites are preventing elevation, so don't need big conversion to open - can do hybrid repair with small incisions" — Don (clinical) [Ep 14 · 22:43](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=1363)
- "Anterior plating of osteotomy sites produces better cosmetic results than suture alone - prevents areas from knobbing up" — Don (clinical) [Ep 14 · 23:01](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=1381)
- "In older patients with calcified cartilages, often cannot do nice cartilage-sparing procedure - it's a mash of calcified cartilage" — Don (clinical) [Ep 14 · 24:56](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=1496)
- "After osteotomy, must stabilize with either suture or plate, otherwise rib won't stay down and will elevate because chest alignment has changed" — Don (clinical) [Ep 14 · 28:37](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=1717)
- "Redo open repairs fall into categories: those that didn't get support and fell in (can re-Nuss), those that are fixed requiring osteotomies, and disasters with holes and malunion" — Don (clinical) [Ep 14 · 30:00](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=1800)
- "All redo open cases are prepped with groins exposed in case of life-threatening bleeding requiring bypass through the groin" — Don (clinical) [Ep 14 · 31:29](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=1889)
- "Redo open cases require both posterior bars for support and anterior plates for stabilization" — Don (clinical) [Ep 14 · 31:43](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=1903)
- "Learned early that redo cases with just bars recurred again when bars were removed, leading to adoption of anterior plating" — Don (clinical) [Ep 14 · 31:43](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=1903)
- "Malunion or pseudoarthrosis can be hard to assess completely by CT scan - better assessed by physical exam" — Don (clinical) [Ep 14 · 32:54](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=1974)
- "Ribs not attached to midline on CT are the best clue for malunion" — Don (clinical) [Ep 14 · 33:09](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=1989)
- "Malunion patients have lot of pain and inability to Valsalva, but Haller index can be almost normal, leading to patients being told they're fine by multiple physicians" — Don (clinical) [Ep 14 · 33:42](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=2022)
- "Chest wall reconstruction for malunion often requires bone graft or methylmethacrylate filler to fill spaces, plus mesh and plating for stabilization" — Don (clinical) [Ep 14 · 34:05](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=2045)
- "For chest wall hernias, can use various materials: methylmethacrylate, titanium mesh, titanium plates, or prefabricated titanium replacement parts" — Don (clinical) [Ep 14 · 40:44](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=2444)
- "Revision patients are never completely happy because they're never normal again - best hope is to make them better" — Don (opinion) [Ep 14 · 41:37](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=2497)
- "When bars are placed and then pulled out and patient collapses, indicates other issues must be addressed beyond just bar replacement" — Don (clinical) [Ep 14 · 41:58](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=2518)
- "After multiple procedures with bars, plating, and continued collapse, difficult to know what will stabilize patients with connective tissue disorders or chests that won't heal, leading to infections and osteonecrosis" — Don (clinical) [Ep 14 · 42:10](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=2530)
- "The best operation is the first operation - need to do the correct operation initially" — Garcia (opinion) [Ep 14 · 43:21](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=2601)
- "Despite appearing simple, pectus surgery has a significant learning curve and is not a see-one-do-one procedure" — Garcia (opinion) [Ep 14 · 43:27](https://qa.library.globalcastmd.com/watch/interesting-cases-surgical-approaches-pectus-innovations-1016?t=2607)
- "Cardiac MRI for pectus assessment uses no contrast and takes approximately 25 minutes" — Michael Taylor (clinical) [Ep 11 · 11:25](https://qa.library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=685)
- "Standard CT dose for pectus can deliver up to 7 millisieverts of radiation, equivalent to 2 years of background radiation" — Eric Crotty (clinical) [Ep 11 · 34:54](https://qa.library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=2094)
- "Approximately 15% of pectus patients in the study (197 total) had right ventricular ejection fraction less than 50%" — Michael Taylor (epidemiological) [Ep 11 · 16:13](https://qa.library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=973)
- "Normal right ventricular ejection fraction is considered to be 50%" — Michael Taylor (clinical) [Ep 11 · 16:18](https://qa.library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=978)
- "Haller found that patients with a Haller index greater than 3.25 were candidates for operation" — Eric Crotty (host_summary) [Ep 11 · 6:15](https://qa.library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=375)
- "The Haller index was based on an observational study, not a rigorous scientific prospective study" — Eric Crotty (clinical) [Ep 11 · 7:01](https://qa.library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=421)
- "Correction index greater than 10% shows no overlap between normal and abnormal patients" — Eric Crotty (host_summary) [Ep 11 · 8:22](https://qa.library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=502)
- "Depression index greater than 0.2 is the cutoff between normal and abnormal patients" — Eric Crotty (host_summary) [Ep 11 · 8:54](https://qa.library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=534)
- "Respiratory phase affects Haller index measurements; some patients with clinical pectus have normal Haller index at end inspiration but abnormal at end expiration" — Eric Crotty (clinical) [Ep 11 · 5:11](https://qa.library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=311)
- "Echocardiogram image quality in pectus patients is poor because the right ventricle and sternum are in the very near field of the transducer" — Michael Taylor (clinical) [Ep 11 · 14:17](https://qa.library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=857)
- "Patients with RV compression had depressed right ventricular ejection fractions, with worse function when compression was on the free wall versus the RA-RV groove" — Michael Taylor (clinical) [Ep 11 · 18:08](https://qa.library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=1088)
- "Children can have right ventricular ejection fractions in the 40s and be asymptomatic" — Michael Taylor (clinical) [Ep 11 · 19:15](https://qa.library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=1155)
- "Exercise testing can reveal decreased RV function that is not apparent at rest in children" — Michael Taylor (clinical) [Ep 11 · 19:22](https://qa.library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=1162)
- "Most MRI scanners and centers should be able to perform cardiac MRI for pectus assessment as the sequences are fairly basic" — Eric Crotty (clinical) [Ep 11 · 22:24](https://qa.library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=1344)
- "Children tolerate MRI very well, especially with video goggle technology allowing them to watch movies during the procedure" — Eric Crotty (clinical) [Ep 11 · 23:00](https://qa.library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=1380)
- "MRI can be performed on patients with pectus bars in place, with only minimal localized artifact where the bar is on top of the heart" — Michael Taylor (clinical) [Ep 11 · 23:53](https://qa.library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=1433)
- "Younger age at CT exposure and higher CT dose increase long-term risk of developing malignancy" — Eric Crotty (clinical) [Ep 11 · 34:13](https://qa.library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=2053)
- "Pediatric tissues have cells that divide more frequently and rapidly, increasing likelihood of radiation-induced DNA breaks and long-term complications" — Eric Crotty (clinical) [Ep 11 · 34:31](https://qa.library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=2071)
- "As pectus patients age, the heart appears to get extruded into the left chest" — Michael Taylor (clinical) [Ep 11 · 21:12](https://qa.library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=1272)
- "Dr. Park in Korea, who performs the largest number of pectus repairs globally, suggests repair is safe in patients older than 3 years" (host_summary) [Ep 11 · 36:48](https://qa.library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=2208)
- "When operating on younger patients, bars need to be shorter to avoid impeding chest wall growth" (clinical) [Ep 11 · 37:15](https://qa.library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=2235)
- "Overcorrection converting excavatum to carinatum can occur, particularly in patients with connective tissue disorders" (clinical) [Ep 11 · 37:45](https://qa.library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=2265)
- "Dr. Park reports seeing fewer asymmetric pectus patients because he corrects them at younger ages" (host_summary) [Ep 11 · 38:18](https://qa.library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=2298)
- "Insurance companies require documentation of abnormal indices and cardiac dysfunction to approve pectus repair" (guideline) [Ep 11 · 25:47](https://qa.library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=1547)
- "Providing multiple indices (Haller, correction, depression) plus evidence of cardiac dysfunction has been effective in reversing insurance denials" (clinical) [Ep 11 · 26:50](https://qa.library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=1610)
- "When the sternum presses on the free wall of the right ventricle, it affects right ventricular function" — Michael Taylor (clinical) [Ep 11 · 27:32](https://qa.library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=1652)
- "Right ventricular strain is markedly decreased in the free wall when compressed by pectus" — Michael Taylor (clinical) [Ep 11 · 27:50](https://qa.library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=1670)
- "Cardiac MRI reports aortic root dimensions and can detect mitral valve prolapse, important in Marfan patients" — Michael Taylor (clinical) [Ep 11 · 28:49](https://qa.library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=1729)
- "There is data suggesting increased risk of malignancy long term from even one CT scan, with risk increasing the younger the patient" — Eric Crotty (clinical) [Ep 11 · 35:57](https://qa.library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=2157)
- "The anatomical assessment portion of cardiac MRI is very straightforward and uses fairly basic sequences" — Eric Crotty (clinical) [Ep 11 · 22:09](https://qa.library.globalcastmd.com/watch/radiology-pectus-innovations-1019?t=1329)
- "Pectus carinatum can be corrected by a number of surgical and non-surgical techniques." (host_summary) [Ep 17 · 0:00](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=0)
- "Minimally invasive repair of pectus carinatum (Abramson or reverse Nuss procedure) can correct the pectus without cartilage resection." (host_summary) [Ep 17 · 0:08](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=8)
- "The two patients were 16-year-old boys who had onset of pectus carinatum at adolescence." (host_summary) [Ep 17 · 0:19](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=19)
- "Correction pressures between 6 and 7 pounds per square inch indicate moderate stiffness of the chest wall." (host_summary) [Ep 17 · 0:27](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=27)
- "Special equipment for this procedure includes 4-hole stabilizers, bendable rib protectors, and the Pioneer sternal cable system, in addition to the Zimmer Biomet pectus tray." (host_summary) [Ep 17 · 0:42](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=42)
- "The procedure is performed under general anesthesia with an epidural catheter for intraoperative and postoperative analgesia." (host_summary) [Ep 17 · 0:58](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=58)
- "Prophylactic antibiotics are given, and a Foley catheter is inserted and kept for 24 hours." (host_summary) [Ep 17 · 1:05](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=65)
- "Bar length is determined by measuring the distance between the two mid-axillary lines at the highest point of the carinatum after correction." (host_summary) [Ep 17 · 1:19](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=79)
- "The end of the bar on each side should correspond to the intercostal space between the two ribs where the stabilizers will be anchored." (host_summary) [Ep 17 · 1:33](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=93)
- "Ribs are cleared of all muscle attachments for a distance of approximately 3 centimeters." (host_summary) [Ep 17 · 1:57](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=117)
- "A 1-inch periosteal incision is made in the rib, and the periosteum is separated from the underlying bone anteriorly and posteriorly." (host_summary) [Ep 17 · 2:13](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=133)
- "A rib protector of similar size to the measured subperiosteal space is bent to the shape of the rib, and a cable is threaded through its holes." (host_summary) [Ep 17 · 2:37](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=157)
- "A small piece of dental wire is used to label the rib protector to facilitate removal from behind the rib in 2 to 3 years." (host_summary) [Ep 17 · 2:58](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=178)
- "A tunnel is created between the muscles and the bony chest wall using a long curved clamp and finger dissection from both sides meeting at the midpoint, completed with the least curved pectus tunneler." (host_summary) [Ep 17 · 3:27](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=207)
- "Sternal wire is placed around a notch in the bar just distal to the stabilizer to lock the bar and stabilizer in position." (host_summary) [Ep 17 · 3:52](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=232)
- "With pressure on the chest to achieve a corrected position, the crimps are locked on the anterior surface of the stabilizer." (host_summary) [Ep 17 · 4:15](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=255)
- "The bar is tightly anchored to 4 ribs, 2 on each side, with the process performed twice on each side." (host_summary) [Ep 17 · 4:24](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=264)
- "The rib protectors prevent the cables from cutting through the ribs." (host_summary) [Ep 17 · 4:32](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=272)
- "Excellent correction was achieved and maintained at one year after repair in both patients." (host_summary) [Ep 17 · 4:48](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=288)
- "In addition to correction of the pectus, lateral chest wall expansion occurred." (host_summary) [Ep 17 · 4:55](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=295)
- "Pectus carinatum can be corrected by a number of surgical and non-surgical techniques." (host_summary) [Ep 18 · 0:00](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=0)
- "Minimally invasive repair of pectus carinatum (Abramson or reverse Nuss procedure) can correct the pectus without cartilage resection." (host_summary) [Ep 18 · 0:08](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=8)
- "Correction pressures between 6 and 7 pounds per square inch indicate moderate stiffness of the chest wall in pectus carinatum." (host_summary) [Ep 18 · 0:27](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=27)
- "Special equipment for minimally invasive pectus carinatum repair includes 4-hole stabilizers, bendable rib protectors, and the Pioneer sternal cable system, in addition to the Zimmer Biomet pectus tray containing tunnelers and bars." (host_summary) [Ep 18 · 0:42](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=42)
- "The procedure is performed under general anesthesia with an epidural catheter for intraoperative and postoperative analgesia." (host_summary) [Ep 18 · 0:58](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=58)
- "Prophylactic antibiotics are given and a Foley catheter is inserted and kept for 24 hours during minimally invasive pectus carinatum repair." (host_summary) [Ep 18 · 1:05](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=65)
- "Bar length for pectus carinatum repair is determined by measuring the distance between the two mid-axillary lines at the highest point of the carinatum after correction." (host_summary) [Ep 18 · 1:19](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=79)
- "The end of the bar on each side should correspond to the intercostal space between the two ribs where the stabilizers will be anchored." (host_summary) [Ep 18 · 1:33](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=93)
- "Ribs are cleared of all muscle attachments for a distance of approximately 3 centimeters during the dissection phase." (host_summary) [Ep 18 · 1:57](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=117)
- "A 1 inch periosteal incision is made in the rib, and the periosteum separated from the underlying bone anteriorly and posteriorly for subperiosteal dissection." (host_summary) [Ep 18 · 2:13](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=133)
- "A rib protector is bent to the shape of the rib and a cable is threaded through its holes before being passed under the rib within the subperiosteal space." (host_summary) [Ep 18 · 2:37](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=157)
- "A small piece of dental wire is used to label the rib protector to facilitate removal from behind the rib in 2 to 3 years." (host_summary) [Ep 18 · 2:58](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=178)
- "A tunnel is created between the muscles and the bony chest wall using a long curved clamp and finger dissection from both sides meeting at the midpoint, completed with the least curved pectus tunneler." (host_summary) [Ep 18 · 3:27](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=207)
- "Sternal wire is placed around a notch in the bar just distal to the stabilizer to lock the bar and stabilizer in position." (host_summary) [Ep 18 · 3:52](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=232)
- "With pressure on the chest to achieve a corrected position, the crimps are locked on the anterior surface of the stabilizer using the Pioneer cable system." (host_summary) [Ep 18 · 4:15](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=255)
- "The bar is tightly anchored to 4 ribs, 2 on each side, after the cable tensioning process is performed twice on each side." (host_summary) [Ep 18 · 4:24](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=264)
- "Rib protectors prevent the cables from cutting through the ribs during pectus carinatum repair." (host_summary) [Ep 18 · 4:32](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=272)
- "Excellent correction was achieved and maintained at one year after minimally invasive pectus carinatum repair in both demonstrated cases." (host_summary) [Ep 18 · 4:48](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=288)
- "In addition to correction of the pectus, lateral chest wall expansion occurred after minimally invasive repair." (host_summary) [Ep 18 · 4:55](https://qa.library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=295)
- "The pectus excavatum clinical care pathway has five major components: pain management, mobility, lung recruitment, daily intake, and daily output." — Rebecca Brown (clinical) [Ep 19 · 0:19](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=19)
- "Preoperatively, compression boots are applied for pectus excavatum repair." — Rebecca Brown (clinical) [Ep 19 · 0:27](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=27)
- "A type and screen is performed preoperatively for pectus excavatum repair." — Rebecca Brown (clinical) [Ep 19 · 0:31](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=31)
- "Ancef is given prior to incision, or vancomycin if the patient is MRSA positive." — Rebecca Brown (clinical) [Ep 19 · 0:33](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=33)
- "Preoperative washes of Dynahex or Hibiclens scrub are applied to prevent infection after pectus excavatum surgery." — Rebecca Brown (clinical) [Ep 19 · 0:33](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=33)
- "Patients are placed on continuous pulse oximetry postoperatively." — Rebecca Brown (clinical) [Ep 19 · 0:46](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=46)
- "Patients are given clear liquids and advanced as tolerated to a full regular diet on postoperative day 0." — Rebecca Brown (clinical) [Ep 19 · 0:49](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=49)
- "Patients are encouraged to be out of bed to the chair and then to ambulate on postoperative day 0, especially if they are the first case of the day." — Rebecca Brown (clinical) [Ep 19 · 0:55](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=55)
- "Incentive spirometry is performed 10 times per hour postoperatively." — Rebecca Brown (clinical) [Ep 19 · 1:01](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=61)
- "Patients receive Ancef times 3 doses postoperatively, or clindamycin if they are MRSA positive." — Rebecca Brown (clinical) [Ep 19 · 1:11](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=71)
- "An epidural is routinely used for pain management after pectus excavatum repair, supplemented with Valium, Robaxin, Toradol, IV Tylenol, methadone times 1, and scheduled Zofran for nausea." — Rebecca Brown (clinical) [Ep 19 · 1:19](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=79)
- "Patients are encouraged to chew gum 5 separate times a day for 20 minutes if fully awake postoperatively." — Rebecca Brown (clinical) [Ep 19 · 1:31](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=91)
- "For bowel management, patients are given Senna and MiraLax twice a day as well as Movantik." — Rebecca Brown (clinical) [Ep 19 · 1:33](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=93)
- "The Foley catheter inserted during surgery is continued on postoperative day 1." — Rebecca Brown (clinical) [Ep 19 · 1:43](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=103)
- "On postoperative day 1, patients are encouraged to be out of bed, up to a chair, and ambulating about the room 3 times a day." — Rebecca Brown (clinical) [Ep 19 · 1:49](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=109)
- "The Foley catheter is removed on postoperative day 1 to encourage ambulation." — Rebecca Brown (clinical) [Ep 19 · 1:56](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=116)
- "On postoperative day 1, the epidural remains in place and medications are supplemented with Valium, Robaxin, Toradol, IV Tylenol, and oxycodone is started orally once patients are tolerating a diet." — Rebecca Brown (clinical) [Ep 19 · 2:03](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=123)
- "Maintenance IV fluids are continued until the patient is drinking well and urinates after Foley removal." — Rebecca Brown (clinical) [Ep 19 · 2:21](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=141)
- "Zofran, initially given routinely every 8 hours, is changed to as needed on postoperative day 1." — Rebecca Brown (clinical) [Ep 19 · 2:34](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=154)
- "On postoperative day 2, IV fluids are discontinued if still running." — Rebecca Brown (clinical) [Ep 19 · 2:49](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=169)
- "The epidural catheter is stopped at 6 in the morning on postoperative day 2." — Rebecca Brown (clinical) [Ep 19 · 2:53](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=173)
- "The epidural is removed when the pain team rounds later in the morning on postoperative day 2." — Rebecca Brown (clinical) [Ep 19 · 2:57](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=177)
- "On postoperative day 2, the patient is transitioned to all oral pain medications including oxycodone, Valium, Robaxin, Motrin, and Tylenol." — Rebecca Brown (clinical) [Ep 19 · 3:01](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=181)
- "A two-view chest X-ray is obtained on postoperative day 2 to evaluate bar location and to rule out any pleural effusion or pneumothorax." — Rebecca Brown (clinical) [Ep 19 · 3:10](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=190)
- "Dressings are removed and the chest is washed daily starting on postoperative day 2." — Rebecca Brown (clinical) [Ep 19 · 3:19](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=199)
- "On postoperative day 2, patients are encouraged to ambulate at least 3 times in the halls." — Rebecca Brown (clinical) [Ep 19 · 3:26](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=206)
- "On postoperative day 3, physical therapy and occupational therapy work with the patient to help them walk up and down the stairs, and PT/OT will sign off once they are able to do this." — Rebecca Brown (clinical) [Ep 19 · 3:51](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=231)
- "Prescriptions are filled and the medication schedule is given to the parent and patients on postoperative day 3." — Rebecca Brown (clinical) [Ep 19 · 4:02](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=242)
- "The patient should be on oral pain medication only by postoperative day 3." — Rebecca Brown (clinical) [Ep 19 · 4:27](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=267)
- "The patient is discharged home on postoperative day 3 if pain is well controlled and the patient is tolerating oral intake." — Rebecca Brown (clinical) [Ep 19 · 4:31](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=271)
- "Since institution of the clinical care pathway about 2 to 3 years ago, length of stay has been reduced from 4.5 days to 3 days." — Rebecca Brown (clinical) [Ep 19 · 4:46](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=286)
- "Since institution of the clinical care pathway about 2 to 3 years ago, patient satisfaction has increased." — Rebecca Brown (clinical) [Ep 19 · 4:46](https://qa.library.globalcastmd.com/watch/pectus-excavatum-pathway-1973?t=286)
- "The CDH study group collected patient data from 2015 to 2018 in a retrospective review of prospectively collected data examining cardiac dysfunction within the first 48 hours of life." — Vic (host_summary) [Ep 21 · 4:31](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=271)
- "Among all CDH patients in the study period, 39% had some evidence of cardiac dysfunction on their first echocardiogram in the first 48 hours of life." — Vic (host_summary) [Ep 21 · 5:19](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=319)
- "Patients with normal cardiac function had a survival of over 80% on adjusted analysis." — Vic (host_summary) [Ep 21 · 5:36](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=336)
- "Patients with right ventricular dysfunction only had a survival of 74%." — Vic (host_summary) [Ep 21 · 5:42](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=342)
- "Patients with left ventricular dysfunction had a survival of 57%." — Vic (host_summary) [Ep 21 · 5:46](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=346)
- "Patients with biventricular dysfunction had a survival of 50%, the worst risk profile." — Vic (host_summary) [Ep 21 · 5:50](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=350)
- "Even when adjusting for liver position, defect size, and other important variables, cardiac dysfunction was still a significant driver of mortality in CDH." — Vic (host_summary) [Ep 21 · 6:01](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=361)
- "The CDH study group does not prescribe standardized management protocols; they allow institutions to report cardiac dysfunction as yes/no and specify whether it is systolic or diastolic." — Vic (clinical) [Ep 21 · 7:01](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=421)
- "Pulmonary hypertension is a predictor of mortality for CDH infants." — Vic (clinical) [Ep 21 · 7:30](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=450)
- "In CDH with pulmonary hypertension, you can see decreased right ventricular ejection, which can lead to bowing of the septum into the left ventricle, resulting in decreased ventricular volumes and decreased ejection." — Vic (clinical) [Ep 21 · 7:35](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=455)
- "The standardized post-operative protocol for Nuss pectus repair included scheduled anti-emetics, epidural pain control discontinued on post-op day 2, early Foley removal, and encouraged ambulation." — Joe La Hillier (host_summary) [Ep 21 · 11:31](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=691)
- "The standardized protocol decreased length of stay following Nuss pectus repair from 4.4 days to 3.4 days." — Joe La Hillier (host_summary) [Ep 21 · 12:06](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=726)
- "There were zero readmissions out of 164 patients in the Nuss pectus repair standardization study." — Joe La Hillier (host_summary) [Ep 21 · 12:15](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=735)
- "The Cincinnati Children's pectus protocol did not use cryotherapy for pain control in any patients." — Joe La Hillier (host_summary) [Ep 21 · 13:57](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=837)
- "The Cincinnati authors acknowledged studies showing cryo versus epidurals showed no difference in pain control but decreased length of stay with cryotherapy, yet expressed reservations due to lack of long-term outcomes data." — Joe La Hillier (host_summary) [Ep 21 · 14:29](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=869)
- "Cryotherapy is gaining traction in pectus repair, with Kansas City publishing multiple studies showing good results." — Todd Ponsky (opinion) [Ep 21 · 14:53](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=893)
- "Protocolizing care leads to improved outcomes, as demonstrated by the pectus repair standardization study." — Todd Ponsky (opinion) [Ep 21 · 15:06](https://qa.library.globalcastmd.com/watch/stay-current-journal-club-episode-1-ventricular-dysfunction-in-cdh-and-3689?t=906)
- "The patient underwent pectus repair surgery on August 1st of the previous year at age 21" — Rebecca Garcia (clinical) [Ep 22 · 0:15](https://qa.library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=15)
- "The patient had previously undergone the Ravitch procedure in Atlanta, Georgia at age 3 or 4 years old" — Rebecca Garcia (clinical) [Ep 22 · 0:22](https://qa.library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=22)
- "Prior to revision surgery, the patient was experiencing chest pains and trouble breathing despite the previous Ravitch procedure" — Rebecca Garcia (clinical) [Ep 22 · 0:22](https://qa.library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=22)
- "Meditation, specifically Jack Kornfield's videos recommended by the surgeon, helped the patient mentally during recovery" — Rebecca Garcia (opinion) [Ep 22 · 1:39](https://qa.library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=99)
- "Post-operative restrictions included inability to turn, twist, or lift more than 5 pounds" — Rebecca Garcia (clinical) [Ep 22 · 2:19](https://qa.library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=139)
- "Walking and staying active were beneficial post-operative activities for this patient" — Rebecca Garcia (opinion) [Ep 22 · 3:14](https://qa.library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=194)
- "Stretching became important for the patient post-operatively, whereas she had not stretched before surgery" — Rebecca Garcia (opinion) [Ep 22 · 3:24](https://qa.library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=204)
- "Robaxin (methocarbamol) helped relieve chest tightness and pressure during home recovery" — Rebecca Garcia (clinical) [Ep 22 · 3:36](https://qa.library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=216)
- "The patient was required to wait 3 months before returning to weight lifting" — Rebecca Garcia (clinical) [Ep 22 · 4:00](https://qa.library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=240)
- "After the 3-month waiting period and gradual return, the patient reported being stronger than ever in the weight room and running" — Rebecca Garcia (clinical) [Ep 22 · 4:32](https://qa.library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=272)
- "Having a pain team and protocol helps patients receive pain medicine faster because they don't have to wait for a doctor to write the order" — Todd Ponsky (clinical) [Ep 22 · 5:41](https://qa.library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=341)
- "The institution screens for resistant staph (MRSA/VRSA) preoperatively" (clinical) [Ep 22 · 7:23](https://qa.library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=443)
- "If patients screen positive for resistant staph, they are swabbed from the nose and underarms and prepared per protocol" (clinical) [Ep 22 · 7:29](https://qa.library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=449)
- "Bactroban is given intranasally twice per day for 7 days prior to surgery for MRSA-positive patients" (clinical) [Ep 22 · 7:40](https://qa.library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=460)
- "Vacuum belts are obtained by communicating directly with suppliers in Germany, providing measurements, and cost approximately $400-500" (clinical) [Ep 22 · 8:11](https://qa.library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=491)
- "For umbilical hernia repairs, one surgeon places no activity restrictions, reasoning that children will self-limit if they experience pain" (clinical) [Ep 22 · 8:40](https://qa.library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=520)
- "The surgeon qualifies the no-restriction approach by restricting organized sports or when the father is a football coach" (clinical) [Ep 22 · 8:58](https://qa.library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=538)
- "For pectus patients, full activity is permitted after 3 months (12 weeks)" (clinical) [Ep 22 · 9:16](https://qa.library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=556)
- "The surgeon acknowledges that adolescent patients do not always adhere to the 3-month activity restriction" (clinical) [Ep 22 · 9:33](https://qa.library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=573)
- "After the 3-month period, stretching and core strength exercises are recommended, with patients given two YouTube videos demonstrating these activities" (clinical) [Ep 22 · 9:54](https://qa.library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=594)
- "A good percentage of lower anterior rib flaring after the Nuss procedure resolves on its own" (clinical) [Ep 22 · 10:45](https://qa.library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=645)
- "At Mayo Clinic, for older patients with rib flaring, ribs below the repair are broken and pushed down, but this technique is less effective in flexible pediatric patients" (host_summary) [Ep 22 · 10:50](https://qa.library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=650)
- "Surgeons in Brazil use a brace for post-operative rib flaring" (host_summary) [Ep 22 · 11:04](https://qa.library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=664)
- "The surgeon's approach to rib flaring is watchful waiting, telling patients to be patient as it improves over time" (clinical) [Ep 22 · 11:10](https://qa.library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=670)
- "Patients are advised to avoid sleeping on their side initially, but if they are comfortable doing so and attempt it, they will self-limit based on discomfort" (clinical) [Ep 22 · 11:33](https://qa.library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=693)
- "Patients naturally sleep on recliners post-operatively because that position is most comfortable" (clinical) [Ep 22 · 11:33](https://qa.library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=693)
- "A future study is planned with cardiologist Michael Taylor to examine post-operative cardiac outcomes in pectus patients" (clinical) [Ep 22 · 13:19](https://qa.library.globalcastmd.com/watch/pectus-patient-testimonial-and-experience-5241?t=799)
- "Pectus excavatum affects 1 in about 400 patients" — Luke Reddick (epidemiological) [Ep 24 · 0:36](https://qa.library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=36)
- "Pectus excavatum has a male predominance at about a 4:1 ratio" — Luke Reddick (epidemiological) [Ep 24 · 0:39](https://qa.library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=39)
- "The Nuss procedure is the gold standard for pectus excavatum fixation" — Luke Reddick (guideline) [Ep 24 · 0:43](https://qa.library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=43)
- "Historically, the Nuss procedure has been associated with a significant amount of pain, leading to increased hospital lengths of stay and costs" — Luke Reddick (clinical) [Ep 24 · 0:46](https://qa.library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=46)
- "Intercostal nerve cryoablation has helped patients with pain and decreased length of stay" — Luke Reddick (clinical) [Ep 24 · 0:57](https://qa.library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=57)
- "Intercostal nerve cryoablation was performed at sites T3 through T7 on both sides of the chest" — Luke Reddick (clinical) [Ep 24 · 1:23](https://qa.library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=83)
- "Patients have been in pain for about 24 hours after intercostal nerve cryoablation because it sometimes takes that long for the full effects to kick in" — Luke Reddick (clinical) [Ep 24 · 1:31](https://qa.library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=91)
- "Bupivacaine was used proximal to the site of intercostal nerve cryoablation for perioperative pain control" — Luke Reddick (clinical) [Ep 24 · 1:55](https://qa.library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=115)
- "10 out of 15 patients in the intervention group (INB) were discharged on postoperative day zero, with the remaining 5 discharged on postoperative day one" — Luke Reddick (clinical) [Ep 24 · 2:42](https://qa.library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=162)
- "None of the patients in the control group (INC) were discharged prior to postoperative day 2" — Luke Reddick (clinical) [Ep 24 · 2:53](https://qa.library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=173)
- "Length of stay was decreased in the intervention group at 12 hours compared to 58 hours in the control group" — Luke Reddick (clinical) [Ep 24 · 2:59](https://qa.library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=179)
- "Cost was statistically significantly less in the intervention group compared to the control group" — Luke Reddick (clinical) [Ep 24 · 3:07](https://qa.library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=187)
- "Opioid use was statistically significantly less in the intervention group than the control group" — Luke Reddick (clinical) [Ep 24 · 3:14](https://qa.library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=194)
- "10 patients in the intervention group never used opioids after discharge, while the remaining 5 used them sparingly" — Luke Reddick (clinical) [Ep 24 · 3:19](https://qa.library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=199)
- "Zero patients in the intervention group returned to the emergency department, whereas 4 in the control group returned to the ED" — Luke Reddick (clinical) [Ep 24 · 3:49](https://qa.library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=229)
- "There was no difference between groups in complications including Foley catheter removal/replacement, pneumothorax requiring chest tube, infections (surgical site and UTI), and returns to urgent care" — Luke Reddick (clinical) [Ep 24 · 3:31](https://qa.library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=211)
- "Medical devices typically are not subjected to the same rigorous, robust trials that drugs are" — Victor Garcia (opinion) [Ep 24 · 4:53](https://qa.library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=293)
- "Many adverse consequences for medical devices are either underreported or not reported, as suggested by Kaiser Health News" — Victor Garcia (opinion) [Ep 24 · 5:24](https://qa.library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=324)
- "The long-term consequences of cryoablation are unknown, particularly for children" — Victor Garcia (opinion) [Ep 24 · 5:41](https://qa.library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=341)
- "There is concern about chronic neuropathic pain as a potential consequence of cryoablation" — Victor Garcia (opinion) [Ep 24 · 5:52](https://qa.library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=352)
- "Long-term neuropathy rate following cryoablation is very low in the presenter's patient population" — Luke Reddick (clinical) [Ep 24 · 6:39](https://qa.library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=399)
- "Before cryoablation, with thoracic epidurals, pectus patients would stay 7-9 days in the hospital" — Luke Reddick (clinical) [Ep 24 · 7:08](https://qa.library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=428)
- "With introduction of intercostal nerve cryoablation, pectus patients were staying in the hospital for 3 days" — Luke Reddick (clinical) [Ep 24 · 7:16](https://qa.library.globalcastmd.com/watch/apsa-is-same-day-discharge-possible-following-the-nuss-repair-for-pectus-excavatum-r-luke-rettig-5422?t=436)
- "In a randomized trial of 110 patients comparing epidural to PCA, maximum pain scores did not drop off in the epidural group due to day 2-3 transition pain, whereas PCA group pain decreased over 4.5 days." — Shawn St. Peter (clinical) [Ep 23 · 3:27](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=207)
- "Cryotherapy technique involves freezing ribs 4 through 7 for two minutes per rib; should not go to rib 8 or below due to risk of abdominal wall paralysis." — Shawn St. Peter (clinical) [Ep 23 · 6:20](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=380)
- "In prospective observational cryoanalgesia study, six of nine patients in initial retrospective cohort went home on post-op day one." — Shawn St. Peter (clinical) [Ep 23 · 7:20](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=440)
- "With cryoanalgesia, length of stay that couldn't get below four days became one day, with tight range except for occasional failures that look like traditional four-day stays." — Shawn St. Peter (clinical) [Ep 23 · 7:55](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=475)
- "Median morphine equivalents with cryoanalgesia versus traditional approaches are not on the same planet in terms of magnitude of difference." — Shawn St. Peter (clinical) [Ep 23 · 8:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=510)
- "Medical devices and implants are not required to undergo clinical trials before market introduction, unlike drugs." — Victor Garcia (guideline) [Ep 23 · 10:40](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=640)
- "Cryotherapy devices received FDA approval via 510(k) predicate pathway based on similarity to devices from 1976, not based on clinical trials." — Victor Garcia (guideline) [Ep 23 · 14:10](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=850)
- "With erector spinae catheters, hospital stay is two days with reduced opioid requirements both in-hospital and post-discharge." — Victor Garcia (clinical) [Ep 23 · 28:20](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1700)
- "When bars flip, it is always technical - related to bar sitting in funky inner space, bad spot, not wrapped tight enough, or not secured well - not related to patient activity or pain modality." — Shawn St. Peter (opinion) [Ep 23 · 30:50](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1850)
- "Activity restrictions beyond two weeks post-Nuss can be liberalized to anything the patient can handle, including bull riding, boxing, football, and hockey." — Shawn St. Peter (clinical) [Ep 23 · 29:24](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1764)
- "In Texas Children's study, 50% of patients still take opioids two weeks after Nuss procedure." — Justin Wagner (host_summary) [Ep 23 · 24:10](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1450)
- "In past five years, hospital length of stay for Nuss procedures has been cut in half through protocol improvements." — Justin Wagner (host_summary) [Ep 23 · 24:40](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1480)
- "In Nebraska protocol without epidurals, catheters, or cryo, length of stay is under two days and patients are off opioids by one week." — Justin Wagner (host_summary) [Ep 23 · 25:20](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1520)
- "In Texas Children's study, urinary retention was 8% in cryo group versus 34% in non-cryo group." — Justin Wagner (host_summary) [Ep 23 · 26:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1560)
- "Bar flippage occurs almost eight times more commonly in cryo group, and allodynia/neuropathy occurs about six times more frequently in cryo group." — Justin Wagner (host_summary) [Ep 23 · 26:25](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1585)
- "In randomized epidural trial, epidural could either not be placed or was removed after one day in approximately 25% of patients." — Whit (host_summary) [Ep 23 · 26:55](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1615)
- "Adult experience using cryotherapy with thoracotomies goes back 20 years without high enough incidence of complications to warrant backing away from the treatment advantage." — Shawn St. Peter (epidemiological) [Ep 23 · 19:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1140)
- "With cryoanalgesia, 70% of patients go home on post-op day one without narcotics." — Steven Rothenberg (clinical) [Ep 23 · 34:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2040)
- "Sternal elevator is used in about 10% of cases, primarily in older males with deep, stiff pectus where flexibility is limited." — Steven Rothenberg (clinical) [Ep 23 · 45:50](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2750)
- "In updated series of 554 patients, bar rotation rate was 0.7%, with most occurring within first few years of surgeon experience." — Shawn St. Peter (epidemiological) [Ep 23 · 39:16](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2356)
- "Pilegaard technique uses shorter bars placed asymmetrically with right side covering two rib spaces and left side with single stabilizer, resulting in well below 1% bar flip rate." — Justin Wagner (host_summary) [Ep 23 · 37:19](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2239)
- "Computational modeling shows flatter bars focus stress on sternum while bigger curved bars have parasitic forces causing unwanted horizontal and torque action at bar ends." — Justin Wagner (host_summary) [Ep 23 · 38:10](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2290)
- "Sub-xiphoid dissection technique allows palpation-guided bar passage and has resulted in 0% incidence of pericarditis." — Shawn St. Peter (clinical) [Ep 23 · 43:20](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2600)
- "Many patients have normal anterior chest sensation even in early post-op phase (two to three weeks) after cryoanalgesia, suggesting nerve stunning rather than complete death." — Shawn St. Peter (clinical) [Ep 23 · 18:20](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1100)
- "Gabapentin is most commonly given once pre-op then 200-300mg three times daily for up to one week post-op; pharmacokinetics suggest starting several days before operation for peak effect." — Justin Wagner (clinical) [Ep 23 · 22:40](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1360)
- "When passing bar from left chest to right chest, the angle avoids pointing directly at the ventricle compared to right-to-left passage." (clinical) [Ep 23 · 41:20](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2480)
- "In 15-patient magnetic repair trial, magnets were safe to place in children's chests and well-tolerated, but results were not as effective as hoped; appears most effective in young children with flexible chests." — Shawn St. Peter (clinical) [Ep 23 · 59:24](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=3564)
- "Cryoanalgesia uses cold temperatures to cause a conduction block, interrupting pain impulses to the brain." — Cecilia Gigena (host_summary) [Ep 26 · 1:57](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=117)
- "Cryoanalgesia technique involves counting down to the 4th rib and freezing underneath it for 2 minutes per rib, treating ribs 4 through 7." (clinical) [Ep 26 · 2:19](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=139)
- "Cryoanalgesia should not be performed on rib 8 or below because it can cause abdominal wall paralysis." (clinical) [Ep 26 · 2:29](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=149)
- "With cryoanalgesia, length of stay decreased from 4 days to 1 day." (clinical) [Ep 26 · 2:37](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=157)
- "Cryoanalgesia dramatically reduced median morphine equivalents compared to previous pain management methods." (clinical) [Ep 26 · 2:46](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=166)
- "There are no long-term studies on cryoanalgesia outcomes." — Victor Garcia (clinical) [Ep 26 · 3:04](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=184)
- "Medical devices and implants are not required to undergo clinical trials before being introduced to market, unlike drugs." — Victor Garcia (guideline) [Ep 26 · 3:24](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=204)
- "The FDA requires clinical trials with long-term results for medications before approval, but not for medical devices and techniques." — Cecilia Gigena (host_summary) [Ep 26 · 3:36](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=216)
- "Erector spinal catheters are placed by the pain team with ultrasound guidance, positioned juxtaposed to but not in the vertebral space." — Victor Garcia (clinical) [Ep 26 · 4:09](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=249)
- "With erector spinal catheters, hospital stay is 2 days, catheters stay in for 5 days, and are pulled out by the family on day 3 while the patient is at home." — Victor Garcia (clinical) [Ep 26 · 4:19](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=259)
- "Erector spinal catheters reduced opioid requirements both in the hospital and outside the hospital." — Victor Garcia (clinical) [Ep 26 · 4:33](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=273)
- "With erector spinal catheters, hospital stays are 2 days, which is much less than the 4-5 days seen with epidurals." — Victor Garcia (clinical) [Ep 26 · 4:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=285)
- "With cryoanalgesia, it is not just when patients go home but how they feel when they go home that has changed dramatically." — Steven Rothenberg (opinion) [Ep 26 · 5:08](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=308)
- "For multimodal pain therapy, the best treatments are preoperative counseling, gabapentin both pre and postoperatively, and then methadone, clonidine, bowel regimen medications, and anti-emetics." — Justin Wagner (clinical) [Ep 26 · 6:02](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=362)
- "In Nebraska, where Steve Rayner practices, length of stay is under 2 days and patients are off opioids by 1 week." — Justin Wagner (host_summary) [Ep 26 · 6:19](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=379)
- "If bars are going to flip, they flip early because they were sitting in a funky inner space, in a bad spot, the bar wasn't wrapped tight enough, or it wasn't secured well." (clinical) [Ep 26 · 6:39](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=399)
- "The bar must sit in a comfortable position before securing it or it probably will not stay there." (clinical) [Ep 26 · 6:54](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=414)
- "Bar flippage is completely a surgical issue." — Steven Rothenberg (opinion) [Ep 26 · 6:59](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=419)
- "Computational modeling showed that shorter flat bars have different stress points compared to traditionally U-shaped bars, with shorter bars having more pressure on the sternum and therefore being more stable." — Justin Wagner (host_summary) [Ep 26 · 7:40](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=460)
- "A sternal elevator is used in about 10% of cases, primarily in really deep stiff pectuses where it allows less tissue damage and a better repair." — Steven Rothenberg (clinical) [Ep 26 · 8:19](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=499)
- "In the average younger patient, thoracoscopy provides adequate visualization without needing a sternal elevator." — Steven Rothenberg (clinical) [Ep 26 · 8:22](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=502)
- "Using a sternal elevator in every case eliminates guesswork and allows entry and exit at the same interspace." — Victor Garcia (clinical) [Ep 26 · 8:35](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=515)
- "Techniques to avoid cardiac injury include thoracoscopy, sternal elevator, vacuum bell in the operating room, or subxiphoid incision." (clinical) [Ep 26 · 8:59](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=539)
- "Passing the bar from left chest to right chest is preferred by some because going right to left means the instrument points directly at the ventricle." (clinical) [Ep 26 · 9:31](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=571)
- "Bar passage direction (left-to-right versus right-to-left) is surgeon preference and probably does not make much difference as long as the substernal space is well dissected and everything is clear." (opinion) [Ep 26 · 10:12](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5807?t=612)
- "Dr. Saint Peter's institution completed a randomized trial of 110 patients comparing epidural to PCA for pectus excavatum pain control, and epidurals did not show superior performance." — Shawn St. Peter (clinical) [Ep 25 · 1:07](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=67)
- "In Dr. Saint Peter's cryoanalgesia trial with approximately 30 patients per group, equipoise was lost when patients went home on post-op day one." — Shawn St. Peter (clinical) [Ep 25 · 1:32](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=92)
- "Cryoanalgesia uses cold temperatures to cause a conduction block that interrupts pain impulses to the brain." — Cecilia Gigena (host_summary) [Ep 25 · 1:57](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=117)
- "The cryoanalgesia technique involves counting down to the 4th rib and freezing underneath it for 2 minutes per rib, treating ribs 4 through 7." — Shawn St. Peter (clinical) [Ep 25 · 2:10](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=130)
- "Cryoanalgesia should not be performed on rib 8 or below because it can cause abdominal wall paralysis." — Shawn St. Peter (clinical) [Ep 25 · 2:29](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=149)
- "With cryoanalgesia, hospital length of stay decreased from 4 days to 1 day at Dr. Saint Peter's institution." — Shawn St. Peter (clinical) [Ep 25 · 2:37](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=157)
- "Cryoanalgesia dramatically reduced median morphine equivalents compared to previous pain management approaches." — Shawn St. Peter (clinical) [Ep 25 · 2:46](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=166)
- "Dr. Garcia's concern about cryoanalgesia is the absence of long-term studies and unknown potential for future adverse effects such as chronic neuropathic pain." — Victor Garcia (opinion) [Ep 25 · 3:01](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=181)
- "Unlike drugs, medical devices and implants are not required to undergo clinical trials before being introduced to the market by the FDA." — Victor Garcia (guideline) [Ep 25 · 3:24](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=204)
- "For medications, the FDA requires clinical trials with long-term clinical results before approval, but this is not required for medical devices and techniques like cryoanalgesia." — Cecilia Gigena (host_summary) [Ep 25 · 3:36](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=216)
- "Dr. Garcia's institution studied approximately 100 patients comparing epidurals to erector spinal catheters for pectus excavatum pain management." — Victor Garcia (clinical) [Ep 25 · 3:55](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=235)
- "Erector spinal catheters are placed by the pain team with ultrasound guidance and are positioned juxtaposed to but not in the vertebral space." — Victor Garcia (clinical) [Ep 25 · 4:08](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=248)
- "With erector spinal catheters, the catheters stay in for 5 days, hospital stay is 2 days, and on the 3rd day while patients are at home, the catheters are pulled out by the family." — Victor Garcia (clinical) [Ep 25 · 4:19](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=259)
- "Dr. Garcia's institution achieved 2-day hospital stays with erector spinal catheters and reduced opioid requirements both in-hospital and at home." — Victor Garcia (clinical) [Ep 25 · 4:31](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=271)
- "Erector spinal catheters achieve shorter stays than the 4-5 days seen with epidurals, though not the one-day stays achieved with cryoanalgesia." — Victor Garcia (clinical) [Ep 25 · 4:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=285)
- "Dr. Rothenberg's initial concerns about cryoanalgesia were the added operative time and concerns about neuralgia and complications." — Steven Rothenberg (opinion) [Ep 25 · 4:53](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=293)
- "After approximately 4 cases, Dr. Rothenberg observed that cryoanalgesia changed not just when patients go home but how they feel when they go home, describing the results as unbelievable." — Steven Rothenberg (opinion) [Ep 25 · 5:08](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=308)
- "Dr. Rothenberg agrees with Dr. Garcia's concerns and supports the need for a registry to track long-term cryoanalgesia outcomes." — Steven Rothenberg (opinion) [Ep 25 · 5:23](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=323)
- "Multimodal pain control options include Tylenol, NSAIDs, precedex for gentle wake-up, dexamethasone for post-anesthetic nausea, and ketamine to avoid opioids." — Justin Wagner (clinical) [Ep 25 · 5:40](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=340)
- "Non-pharmacologic multimodal approaches include child life specialists, mindfulness resources, and supportive physical therapists." — Justin Wagner (clinical) [Ep 25 · 5:55](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=355)
- "Dr. Ponsky's best multimodal treatments are preoperative counseling, gabapentin both pre and postoperatively, methadone, clonidine, bowel regimen medications, and anti-emetics." — Justin Wagner (host_summary) [Ep 25 · 6:02](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=362)
- "At the institution where Dr. Wagner trained in Nebraska, Steve Rayner achieves length of stay under 2 days with patients off opioids by 1 week." — Justin Wagner (host_summary) [Ep 25 · 6:19](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=379)
- "Bar flippage typically occurs early and is caused by the bar sitting in a funky interspace, sitting in a bad spot, not being wrapped tight enough, or not being secured well." — Shawn St. Peter (clinical) [Ep 25 · 6:39](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=399)
- "The bar must sit in a comfortable position before securing or it will not stay in place; securing alone does not prevent bar flippage." — Shawn St. Peter (clinical) [Ep 25 · 6:54](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=414)
- "Dr. Rothenberg believes bar flippage is completely a surgical issue, not related to pain management technique." — Steven Rothenberg (opinion) [Ep 25 · 6:59](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=419)
- "Physics-minded surgeons created a computational model showing that shorter flat bars have more pressure on the sternum compared to traditionally U-shaped bars, making them more stable." — Justin Wagner (host_summary) [Ep 25 · 7:36](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=456)
- "Dr. Wolon uses a sternal elevator for pectus excavatum repair at Akron Children's Hospital." — Victor Garcia (host_summary) [Ep 25 · 8:08](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=488)
- "Dr. Rothenberg uses a sternal elevator in about 10% of cases, primarily in really deep stiff pectuses where it allows less tissue damage and a better repair." — Steven Rothenberg (clinical) [Ep 25 · 8:19](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=499)
- "In average younger patients, thoracoscopy provides adequate visualization without needing a sternal elevator." — Steven Rothenberg (clinical) [Ep 25 · 8:22](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=502)
- "Dr. Garcia uses the sternal elevator in every case because it eliminates guesswork and allows entry and exit at the same interspace." — Victor Garcia (clinical) [Ep 25 · 8:35](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=515)
- "Dr. Saint Peter continues to use subxiphoid incision along with thoracoscopy, sternal elevator, or vacuum bell in the operating room as safety techniques to avoid cardiac injury." — Shawn St. Peter (clinical) [Ep 25 · 8:50](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=530)
- "Dr. Holcomb's principle is that whatever technique helps avoid injuring the heart is the technique that should be used." — Shawn St. Peter (host_summary) [Ep 25 · 9:05](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=545)
- "One surgeon passes the bar from left chest to right chest because passing right to left directs the instrument toward the ventricle." (clinical) [Ep 25 · 9:31](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=571)
- "Dr. Slater has always performed the Nuss procedure right to left and had not previously considered left to right." — Cecilia Gigena (host_summary) [Ep 25 · 9:41](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=581)
- "One surgeon learned left to right but switched to right to left and found it easier, particularly when using external elevator and thoracoscopy for safety." — Shawn St. Peter (clinical) [Ep 25 · 9:54](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=594)
- "Direction of bar passage is likely surgeon preference and does not make much difference as long as the substernal space is well dissected and everything is clear." — Shawn St. Peter (opinion) [Ep 25 · 10:12](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-5806?t=612)
- "The Titanic Index measures the percentage of sternum that lies under the anterior costal line in pectus excavatum patients." — Luzia Toselli (clinical) [Ep 31 · 2:00](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=120)
- "A Titanic Index cutoff of 66.5% predicts need for more than two bars with sensitivity of 93% and specificity of 92%." — Luzia Toselli (clinical) [Ep 31 · 3:00](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=180)
- "The study included 78 pectus excavatum patients between 2020 and 2022, with 47% receiving two bars and 53% receiving more than two bars." — Luzia Toselli (epidemiological) [Ep 31 · 2:30](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=150)
- "The Titanic Index provides an objective way to determine bar number rather than guessing based on eyeballing or age." — Ellen Encisco (host_summary) [Ep 31 · 3:59](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=239)
- "Severe outcomes in button battery ingestion were defined as deep mucosal erosion, perforation, mediastinitis, vascular or airway injury or fistula, or esophageal stricture development." — Ellen Encisco (host_summary) [Ep 31 · 5:36](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=336)
- "The Boston Children's study included 143 patients under 21 years old from 2008 to 2021, with 24 having severe outcomes." — Ellen Encisco (host_summary) [Ep 31 · 6:05](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=365)
- "Three predictive factors for severe button battery outcomes are: battery in esophagus at presentation, battery size ≥2cm, and presence of any symptoms." — Ellen Encisco (host_summary) [Ep 31 · 6:20](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=380)
- "Time to button battery removal was not a significant predictor of severe outcomes in the Boston series." — Farokh Demeri (clinical) [Ep 31 · 7:24](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=444)
- "The national database study included 577 pediatric choledochal cyst patients aged 0-21 years from 2016 to 2018, with 28% undergoing laparoscopic and 72% open resection." — Chad Thorson (epidemiological) [Ep 31 · 8:54](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=534)
- "Most open choledochal cyst procedures were hepaticojejunostomy while most laparoscopic procedures were hepaticoduodenostomy." — Chad Thorson (clinical) [Ep 31 · 9:27](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=567)
- "Patients receiving open choledochal cyst operations had inferior outcomes including longer length of stay, higher cost, increased TPN use, and more central line requirements." — Chad Thorson (clinical) [Ep 31 · 9:27](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=567)
- "There was no significant difference in post-operative cholangitis or mortality between laparoscopic and open choledochal cyst resection despite different anastomosis types." — Mark Wulkan (host_summary) [Ep 31 · 10:32](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=632)
- "Laparoscopic biliary anastomosis for choledochal cysts has a learning curve and is not recommended for early career surgeons without assistance." (opinion) [Ep 31 · 10:54](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=654)
- "The Titanic Index is useful in clinical practice for preoperative planning of pectus excavatum repair." — Luzia Toselli (opinion) [Ep 31 · 4:25](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=265)
- "The risk score for button battery ingestion can help determine whether transfer to a specialized facility is needed." — Mark Wulkan (host_summary) [Ep 31 · 6:33](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=393)
- "The Haller index and correction index are currently primarily used indices for pectus excavatum and tell us about the severity of the deformity." — Ellen Encisco (host_summary) [Ep 37 · 1:12](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-13-7638?t=72)
- "The Titanic index is the percentage of the sternum that lies behind the anterior costal line as seen on CT scans." — Ellen Encisco (host_summary) [Ep 37 · 1:20](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-13-7638?t=80)
- "There is a weak correlation between the Titanic index and the other indices (Haller and correction indices)." — Ellen Encisco (host_summary) [Ep 37 · 1:44](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-13-7638?t=104)
- "The Titanic index might be more helpful for determining how many bars a patient is going to need for pectus excavatum repair." — Ellen Encisco (host_summary) [Ep 37 · 1:44](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-13-7638?t=104)
- "A Titanic index threshold of 66.5% was established, meaning patients with a higher index than that probably needed more than 2 bars for pectus excavatum repair." — Ellen Encisco (host_summary) [Ep 37 · 1:55](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-13-7638?t=115)
- "Early initiation of peritoneal dialysis was associated with decreased post-operative mortality in infants after pediatric cardiac surgery." — Alex Halpern (host_summary) [Ep 37 · 2:35](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-13-7638?t=155)
- "Early initiation of peritoneal dialysis shortened duration of mechanical ventilation in infants after pediatric cardiac surgery." — Alex Halpern (host_summary) [Ep 37 · 2:41](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-13-7638?t=161)
- "Early initiation of peritoneal dialysis shortened length of stay in the ICU in infants after pediatric cardiac surgery." — Alex Halpern (host_summary) [Ep 37 · 2:41](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-13-7638?t=161)
- "In a Boston Children's Hospital study of 143 button battery ingestion patients from 2008 to 2021, 24 had severe outcomes." — Cecilia Gigena (host_summary) [Ep 37 · 3:16](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-13-7638?t=196)
- "Location of the button battery in the esophagus is an independent predictor for severe outcomes in button battery ingestion." — Cecilia Gigena (host_summary) [Ep 37 · 3:37](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-13-7638?t=217)
- "A button battery larger than 2 centimeters is an independent predictor for severe outcomes in button battery ingestion." — Cecilia Gigena (host_summary) [Ep 37 · 3:45](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-13-7638?t=225)
- "Having symptoms at presentation is an independent predictor for severe outcomes in button battery ingestion." — Cecilia Gigena (host_summary) [Ep 37 · 3:49](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-13-7638?t=229)
- "The cryoanalgesia study compared patients from 2011 to 2021, with 29 patients receiving cryoanalgesia and 15 not receiving it." — Cecilia Gigena (host_summary) [Ep 41 · 1:39](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=99)
- "Patients who received cryoanalgesia had shorter hospital stays: 3.0 days versus 5.4 days for those without cryoanalgesia." — Cecilia Gigena (host_summary) [Ep 41 · 1:48](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=108)
- "Hospital costs were slightly lower (less than $1000 difference) in patients who received cryoanalgesia despite the expensive equipment." — Cecilia Gigena (host_summary) [Ep 41 · 2:00](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=120)
- "Cryoanalgesia was associated with a 70% decrease in complication rates, from approximately 33% down to 17%." — Mary Brindle (host_summary) [Ep 41 · 2:31](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=151)
- "The chest tube study included 130 lung resections performed between 2013 and 2022." — Mary Brindle (host_summary) [Ep 41 · 3:48](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=228)
- "Of the 130 procedures, 59 were lobectomies (group 1), 19 were diagnostic wedge resections (group 2), and 52 were excisional wedge resections (group 3)." — Em Gootee (host_summary) [Ep 41 · 3:55](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=235)
- "In lobectomy patients (group 1), 75% had no air leak and median chest tube duration was 2 days." — Jamie Schnuck (host_summary) [Ep 41 · 4:12](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=252)
- "In diagnostic wedge resection patients (group 2), nearly 90% had no air leak and median chest tube duration was 1 day." — Em Gootee (host_summary) [Ep 41 · 4:30](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=270)
- "In excisional wedge resection patients (group 3), 80% had no air leak and median chest tube duration was 1 day." — Em Gootee (host_summary) [Ep 41 · 4:39](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=279)
- "Most chest tubes were removed on the first day after surgery and a majority of patients did not have an air leak." — Jamie Schnuck (host_summary) [Ep 41 · 4:48](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=288)
- "The pilonidal disease study included 198 patients presenting between 2019 and 2022, with data prospectively gathered in a retrospective study design." — Mary Brindle (host_summary) [Ep 41 · 6:37](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=397)
- "The pilonidal disease cohort included 21 patients with skin types 1-2, 156 with skin types 3-4, and 21 with skin types 5-6, with approximately 151 having dark colored hair." — Cecilia Gigena (host_summary) [Ep 41 · 6:51](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=411)
- "To reach 75% hair reduction requires a mean of 4.8 to 6.8 laser ablation sessions depending on skin and hair characteristics." — Cecilia Gigena (host_summary) [Ep 41 · 7:34](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=454)
- "Dark hair and skin types 5-6 were associated with higher recurrence rates in pilonidal disease after laser hair reduction." — Cecilia Gigena (host_summary) [Ep 41 · 7:47](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=467)
- "The overall recurrence rate for pilonidal disease after laser hair reduction was 6%." — Cecilia Gigena (host_summary) [Ep 41 · 7:47](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=467)
- "Insurance coverage for laser hair reduction varies, with some agencies covering it while in Canada advocacy to health systems is needed, making effectiveness data important for coverage decisions." — Mary Brindle (opinion) [Ep 41 · 8:12](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=492)
- "All three articles were chosen as PAPS Award winners at the annual conference." — Mary Brindle (clinical) [Ep 41 · 8:55](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=535)
- "The three studies represent evolutionary (rather than revolutionary) advances important for day-to-day pediatric surgical care management." — Mary Brindle (opinion) [Ep 41 · 9:01](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=541)
- "Pectus arcuatum is a bony deformity caused by a premature obliteration of the sternal sutures, resulting in a short sternum bent on itself." — Sahab Delaville (clinical) [Ep 42 · 2:07](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=127)
- "In the pectus arcuatum study, 34 patients were reviewed with a mean age of 10 years, and 47% required X-ray or CT scan for diagnosis." — Cecilia Gigena (host_summary) [Ep 42 · 1:43](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=103)
- "35% of pectus arcuatum cases had associated malformations like Noonan syndrome, scoliosis, or cardiopathy." — Sahab Delaville (epidemiological) [Ep 42 · 2:40](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=160)
- "25% of pectus arcuatum patients had a skeletal malformation in their family." — Sahab Delaville (epidemiological) [Ep 42 · 2:40](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=160)
- "For pectus arcuatum treatment, bracing does not work and surgery requiring sternotomy is necessary." — Sahab Delaville (clinical) [Ep 42 · 2:40](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=160)
- "Patients diagnosed with pectus arcuatum should be evaluated for cardiac malformation with ultrasound and assessed for scoliosis." — Sahab Delaville (guideline) [Ep 42 · 3:13](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=193)
- "The Boston CDH study reviewed 146 infants who underwent CDH repair while on ECMO support from 1995 to 2021." — Em Gootee (host_summary) [Ep 42 · 4:24](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=264)
- "Early CDH repair was defined as during the first 48 hours after ECMO cannulation, and delayed repair was anything after that time." — Whit Holcomb (host_summary) [Ep 42 · 4:40](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=280)
- "Surgical bleeding risk for CDH repair on ECMO was approximately 1% if operated in less than 24 hours, 5-6% at 48 hours, and jumped to maybe 15% after 48 hours." — Jason Smithers (clinical) [Ep 42 · 4:58](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=298)
- "Duration of ECMO support was shorter in the early CDH repair group." — Em Gootee (host_summary) [Ep 42 · 5:17](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=317)
- "Survival was not statistically different between early and delayed CDH repair groups." — Em Gootee (host_summary) [Ep 42 · 5:17](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=317)
- "The Boston center historically preferred early CDH repair for patients on ECMO, so patients who had delayed repair may have had clinical differences." — Em Gootee (host_summary) [Ep 42 · 5:56](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=356)
- "Some pediatric surgeons perform CDH repair after the patient gets off ECMO rather than while on ECMO." — Whit Holcomb (clinical) [Ep 42 · 6:21](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=381)
- "If CDH repair is only performed off ECMO, a certain number of patients die because they never came off ECMO." — Jason Smithers (clinical) [Ep 42 · 6:46](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=406)
- "One key to CDH management is to promote lung growth after repair, optimizing contralateral lung growth rather than ipsilateral lung growth." — Jason Smithers (clinical) [Ep 42 · 6:53](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=413)
- "The ERAS meta-analysis examined 10 studies involving 1300 patients from databases including PubMed, Embase, and Cochrane Library." — Whit Holcomb (host_summary) [Ep 42 · 7:29](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=449)
- "ERAS protocols significantly reduce intraoperative fluids needed and postoperative opiate use in pediatric colorectal surgery." — Cecilia Gigena (host_summary) [Ep 42 · 7:41](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=461)
- "Time to first oral intake and time for complete nutrition was less in patients managed with ERAS protocols." — Cecilia Gigena (host_summary) [Ep 42 · 7:55](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=475)
- "ERAS protocols have a beneficial role in accelerating rehabilitation and shortening length of hospitalization." — Whit Holcomb (host_summary) [Ep 42 · 8:09](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=489)
- "Physician suicide rates are tragically high among doctors compared to the general population." — Em Gootee (host_summary) [Ep 42 · 9:16](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=556)
- "Factors contributing to physician suicide include high levels of stress, emotional and physical burnout, demanding work schedules, and pressure to maintain a successful career." — Em Gootee (host_summary) [Ep 42 · 10:11](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=611)
- "Stigma associated with mental health issues within the medical profession discourages physicians from seeking help, leading to untreated depression, anxiety, and other mental health disorders." — Em Gootee (host_summary) [Ep 42 · 10:33](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=633)
- "Every surgeon will have adversity in practice with patients where despite best efforts there is not a good result." — Whit Holcomb (opinion) [Ep 42 · 9:47](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=587)
- "Support systems are available to help physicians through difficult situations and adversity." — Whit Holcomb (clinical) [Ep 42 · 9:55](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=595)
- "Physician mental health is discussed more openly now versus 10 years ago, but should still be discussed more openly." — Whit Holcomb (opinion) [Ep 42 · 11:30](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=690)
- "The appendicitis study compared two cohorts defined by time frame before and after near uniform implementation of stopping antibiotics at discharge." — Scott Short (clinical) [Ep 44 · 2:07](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=127)
- "The appendicitis study looked at deep space organ infections, length of stay, readmissions, and use of CT scans as outcomes." — Romeo Ignacio (host_summary) [Ep 44 · 2:33](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=153)
- "The appendicitis study had 185 patients in the home antibiotic group and 121 patients in the no home antibiotic group." — Cecilia Gigena (host_summary) [Ep 44 · 2:45](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=165)
- "There was no significant difference in deep organ space infection requiring intervention between home antibiotic and no home antibiotic groups for complicated appendicitis." — Cecilia Gigena (host_summary) [Ep 44 · 2:55](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=175)
- "There was no difference in length of stay between home antibiotic and no home antibiotic groups for complicated appendicitis." — Cecilia Gigena (host_summary) [Ep 44 · 3:03](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=183)
- "Secondary outcomes including C. diff infections, superficial site infections, length of stay, post-operative CT imaging, and readmission showed no difference between antibiotic groups." — Romeo Ignacio (host_summary) [Ep 44 · 3:06](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=186)
- "The appendicitis study challenges the tradition of giving antibiotics and possibly too much antibiotics after discharge." — Romeo Ignacio (opinion) [Ep 44 · 3:17](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=197)
- "The next step for the appendicitis study is to roll it out to the Western Pediatric Surgery Research Consortium to study it on a broader scale." — Scott Short (clinical) [Ep 44 · 3:55](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=235)
- "The esophageal atresia study is a 25 year experience describing 220 consecutive infants with esophageal atresia in Newcastle." — Mark Davenport (host_summary) [Ep 44 · 4:44](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=284)
- "The esophageal atresia study had 215 patients, 13% had complex esophageal atresia, and of those 25 patients survived the repair." — Em Gootee (host_summary) [Ep 44 · 5:13](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=313)
- "Of the 25 complex esophageal atresia survivors, 14 patients were type A and 11 patients were type C." — Em Gootee (host_summary) [Ep 44 · 5:28](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=328)
- "Type C esophageal atresia is the most common type and means esophageal atresia with a distal fistula; type A means pure esophageal atresia with no fistula to the trachea." — Cecilia Gigena (clinical) [Ep 44 · 5:43](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=343)
- "Of the 25 complex esophageal atresia patients, 18 had delayed primary anastomosis and 7 had esophageal replacement." — Em Gootee (host_summary) [Ep 44 · 6:03](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=363)
- "Two of the esophageal replacements were salvage procedures following a failed traction." — Em Gootee (host_summary) [Ep 44 · 6:13](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=373)
- "Only 4 patients with esophageal atresia were potentially treatable by traction." — Em Gootee (host_summary) [Ep 44 · 6:13](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=373)
- "The esophagus has a great intrinsic blood supply and can be mobilized right down to the diaphragm and right up to the thoracic inlet and will stay alive." — Bruce Jaffray (clinical) [Ep 44 · 6:28](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=388)
- "Many cases being put forward for lengthening are because surgeons get cold feet about attempting a primary anastomosis." — Bruce Jaffray (opinion) [Ep 44 · 6:46](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=406)
- "In cases where traction techniques had not been attempted, the native esophagus was retained in 80% of cases." — Em Gootee (host_summary) [Ep 44 · 6:57](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=417)
- "The median time to esophageal continuity in the Newcastle series was 77 days." — Em Gootee (host_summary) [Ep 44 · 7:02](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=422)
- "Management of complex esophageal atresia without lengthening procedure can result in a similar rate of retention of the native esophagus but with significantly less morbidity." — Em Gootee (host_summary) [Ep 44 · 7:12](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=432)
- "The Newcastle series is a pushback series which extols relatively conventional open surgery and begs the question as to what role lengthening procedures have in those with long gaps." — Mark Davenport (opinion) [Ep 44 · 7:32](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=452)
- "Unless an experienced surgeon says after maximum mobilization they genuinely can't get the esophagus together, esophageal lengthening is not required." — Bruce Jaffray (opinion) [Ep 44 · 7:56](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=476)
- "If esophaguses were being anastomosed with excess tension and repairs were failing, there would be a very high incidence of esophageal replacement, which is not seen in the Newcastle series." — Bruce Jaffray (clinical) [Ep 44 · 8:09](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=489)
- "The pectus study is a prospective cohort study from a single center in Phoenix aiming to quantify long-term hyperesthesia and neuropathic pain after minimally invasive repair of pectus excavatum with cryoablation." — Cecilia Gigena (host_summary) [Ep 44 · 8:47](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=527)
- "The pectus study selected patients under 21 years of age who presented for bar removal between November 2021 and May 2023." — Cecilia Gigena (host_summary) [Ep 44 · 9:04](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=544)
- "Testing for cold and soft touch and pinprick was performed just before bar removal." — Cecilia Gigena (host_summary) [Ep 44 · 9:15](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=555)
- "The pectus study enrolled 47 patients with a median bar dwell time of approximately 2.9 years." — Cecilia Gigena (host_summary) [Ep 44 · 9:25](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=565)
- "Patients had a median of 2 bars placed, and almost 81% were secured with pericostal sutures." — Cecilia Gigena (host_summary) [Ep 44 · 9:41](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=581)
- "Almost half of the pectus patients had some degree of hypoesthesia, with T5 being the most common dermatome affected." — Cecilia Gigena (host_summary) [Ep 44 · 9:51](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=591)
- "The area with hypoesthesia was less than 5% of the entire surface that was treated with cryo." — Cecilia Gigena (host_summary) [Ep 44 · 10:00](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=600)
- "Neuropathic symptoms were identified by only 13% of pectus patients, and none required treatment." — Cecilia Gigena (host_summary) [Ep 44 · 10:18](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=618)
- "In the long term after minimally invasive repair of pectus excavatum with cryo, many patients will experience some chest wall hypoesthesia limited to one or two dermatomes, and chronic symptomatic neuropathic pain is very rare." — Cecilia Gigena (host_summary) [Ep 44 · 10:26](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=626)
- "Pericostal sutures used to secure bars can damage nerves." — Cecilia Gigena (clinical) [Ep 44 · 11:00](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-q1-2024-8754?t=660)
- "Cryoanalgesia is a minimally invasive procedure to repair pectus excavatum or alleviate pain during surgery on the chest wall that temporarily blocks nerve conduction along peripheral nerve pathways and relieves pain by freezing the affected nerve." — Lizzie Lee (host_summary) [Ep 46 · 0:57](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=57)
- "The freeze point is in the posterior axillary line, 4 centimeters from the vertebral column." — Lizzie Lee (host_summary) [Ep 46 · 1:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=90)
- "With the original cryoprobe, it's a 2-minute freeze cycle." — Lizzie Lee (host_summary) [Ep 46 · 1:36](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=96)
- "Doctor De Fiori performs cryoanalgesia from T3 to T8, although most of the literature is just to T7." — John De Fiori (clinical) [Ep 46 · 1:39](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=99)
- "Subpleural injection with 0.25% marcaine with epinephrine works immediately, as opposed to the 8 to 10 hour delay with the cryo nerve block." — Lizzie Lee (host_summary) [Ep 46 · 2:02](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=122)
- "Subpleural injection takes only 15 seconds per interspace." — Lizzie Lee (host_summary) [Ep 46 · 2:13](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=133)
- "50% of the update course audience has never used cryoanalgesia." — Lizzie Lee (host_summary) [Ep 46 · 2:26](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=146)
- "About 40% of the update course responders answered that cost is the main reason they don't use cryoanalgesia." — Lizzie Lee (host_summary) [Ep 46 · 2:33](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=153)
- "Doing T3 to T8 bilaterally with the new probe saves almost 30 minutes." — Lizzie Lee (host_summary) [Ep 46 · 2:55](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=175)
- "The new probe tip gets down to temperature about 20 seconds faster, the freeze cycle is 90 seconds instead of 2 minutes, and it's 15 seconds less to thaw back to temperature." — John De Fiori (clinical) [Ep 46 · 2:59](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=179)
- "The new probe has improved shaft insulation so that it can actually touch the lung, since it only reaches room temperature." — Lizzie Lee (host_summary) [Ep 46 · 3:10](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=190)
- "A Chicago paper showed that a 1 minute freeze cycle instead of a 2 minute freeze cycle had nerve blocks that were just as effective." — John De Fiori (host_summary) [Ep 46 · 3:38](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=218)
- "The Chicago study was limited because they did not measure pain scores or compare the 1 minute freeze cycle directly to 2-minute freeze cycles." — Lizzie Lee (host_summary) [Ep 46 · 3:48](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=228)
- "A new 10 millimeter probe with a 60-second freeze cycle that gets down quicker is coming out on October 1st." — John De Fiori (clinical) [Ep 46 · 3:58](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=238)
- "There is a risk of pneumothorax from the lung tearing after inadvertent adhesion to the cryoprobe." — Lizzie Lee (host_summary) [Ep 46 · 4:13](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=253)
- "The double lumen endotracheal tube helps minimize pneumothorax risk by deflating the lung and maximizing working space so that the cryoprobe does not touch the lung." — Lizzie Lee (host_summary) [Ep 46 · 4:19](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=259)
- "Doctor De Fiori uses double lumen tube in all cases because the exposure of the intercostal nerves is exceptional and it ensures that the block is applied posterior enough to get the lateral cutaneous branch." — John De Fiori (opinion) [Ep 46 · 4:27](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=267)
- "A major advantage of the double lumen tube over the single lumen tube is that it helps prevent the nerve block from being done too far anteriorly, which will make the nerve block ineffective." — Lizzie Lee (host_summary) [Ep 46 · 4:39](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=279)
- "Doctor De Fiori has gotten multiple calls from other surgeons saying sometimes their blocks don't work, and invariably it's a surgeon using a single lumen tube doing the block too far anteriorly because they can't get posterior to the anterior axillary line." — John De Fiori (clinical) [Ep 46 · 4:50](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=290)
- "Doctor Sung Kim did a cadaver study at UCSF showing that 18% of the lateral cutaneous branch nerves are posterior to the mid axillary line." — Lizzie Lee (host_summary) [Ep 46 · 5:13](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=313)
- "If you don't get posterior enough with the cryoprobe, that's when you get blocks that are ineffective." — John De Fiori (clinical) [Ep 46 · 5:23](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=323)
- "Some surgeons have success with using a single lumen tube doing a mediastinal dissection, going across from the right to the left side." — Lizzie Lee (host_summary) [Ep 46 · 5:31](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=331)
- "Doctor Kim showed in the study that there is a large collateral branch of the intercostal nerve that runs along the top of the nerve, separate from the main intercostal branch on the bottom of the nerve." — John De Fiori (host_summary) [Ep 46 · 5:46](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=346)
- "In a small group of patients, Doctor Kim cryoablated the main intercostal nerve at the bottom of the rib and the collateral branch at the top of the rib below it." — Lizzie Lee (host_summary) [Ep 46 · 5:58](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=358)
- "As you move down toward T7 and T8, the interspace will widen enough to freeze both the main nerve and collateral branch." — Lizzie Lee (host_summary) [Ep 46 · 6:12](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=372)
- "Doctor De Fiori has done the double freeze technique (main nerve and collateral branch) in 20 patients, and peak pain scores have dropped from about 5 to about 3." — John De Fiori (clinical) [Ep 46 · 6:17](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=377)
- "The double freeze technique hasn't affected Doctor De Fiori's length of stay because 98% of his patients go home the next day anyway." — John De Fiori (clinical) [Ep 46 · 6:26](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=386)
- "In the UCSF study, when they did 2 freeze points per interspace on 22 patients, the length of stay decreased from 2 days to 1 day." — Lizzie Lee (host_summary) [Ep 46 · 6:32](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=392)
- "In the UCSF study, 9 out of the 22 patients reported pain scores of 0." — Lizzie Lee (host_summary) [Ep 46 · 6:42](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=402)
- "The new probe takes half the amount of time, and Doctor De Fiori is now doing double the number of blocks." — John De Fiori (clinical) [Ep 46 · 6:51](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=411)
- "Cryoanalgesia controls pain and decreases hospital length of stay with few short-term complications." — Lizzie Lee (host_summary) [Ep 46 · 7:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-cryoanalgesia-in-pectus-cases-2024-10194?t=420)
- "At Cincinnati Children's, interventional radiologists teach pediatric surgery fellows how to use ultrasound guidance for vascular access." (host_summary) [Ep 50 · 0:53](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=53)
- "You don't have to have a hybrid OR to do image-guided surgery collaboration; it can occur in a regular OR by bringing in an ultrasound machine." (host_summary) [Ep 50 · 1:02](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=62)
- "Cone beam CT is performed on a C-arm fluoroscopy unit that rotates around the patient collecting multiple images which are stacked together to create a CT." (clinical) [Ep 50 · 1:25](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=85)
- "ChatGPT can screen thousands of articles in systematic reviews by analyzing Excel sheets and screening included articles based on title and abstract." (host_summary) [Ep 50 · 2:20](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=140)
- "In cryoanalgesia for pectus procedures, a double lumen endotracheal tube is used in all patients to deflate the lung on the side of cryoablation." (host_summary) [Ep 50 · 4:35](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=275)
- "Cryoanalgesia targets nerves from T3 to T8 with a 2-minute freeze cycle starting at the third rib and working down." (host_summary) [Ep 50 · 4:46](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=286)
- "Subpleural injection with 0.25% marcaine with epinephrine works immediately, as opposed to the 8 to 10 hour delay with cryo nerve block." (host_summary) [Ep 50 · 4:56](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=296)
- "Cryoanalgesia blocks fail when surgeons use a single lumen tube and perform the block too far anteriorly." (host_summary) [Ep 50 · 5:13](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=313)
- "The SER Protocol from Michigan used prenatal criteria to guide decisions on offering ECMO versus comfort care for severe unilateral CDH, and outcomes showed survival was equivalent between groups." (host_summary) [Ep 50 · 6:43](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=403)
- "Every unilateral isolated CDH should be pursued with ECMO if there was good prenatal counseling with the parents." (host_summary) [Ep 50 · 6:58](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=418)
- "With bivalrudin, you can operate after 8 hours of putting patients on ECMO as long as levels are stable, and it's a much easier surgical repair." (host_summary) [Ep 50 · 7:26](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=446)
- "Early repair while on ECMO is safe and can offer physiological benefits, with the optimal window between 8 to 24 hours." (host_summary) [Ep 50 · 7:41](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=461)
- "CO2 laser emits infrared light in the spectrum of 920 to 1400 nanometers, which is well absorbed by water." (host_summary) [Ep 50 · 8:14](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=494)
- "In 56 circumcision cases using CO2 laser with the sleeve technique, dorsal slit, and cyanoacrylate adhesive, the complication rate was only 3%." (host_summary) [Ep 50 · 8:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=510)
- "CO2 laser was used for frenulectomy in 47 patients with low pain profile and no suture required." (host_summary) [Ep 50 · 8:40](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=520)
- "Autofluorescence has shown to reduce rates of hypoparathyroidism and hypocalcemia following thyroidectomy in a randomized controlled trial from France." (host_summary) [Ep 50 · 9:37](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=577)
- "With autofluorescence, parathyroids naturally autofluoresce at a specific wavelength without injecting anything." (clinical) [Ep 50 · 9:53](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=593)
- "Hypocalcemia rates were about 50% lower with autofluorescence use versus not using it." (epidemiological) [Ep 50 · 10:07](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=607)
- "A surgery-first pathway for pediatric biliary stones reduces resource utilization, including MRCP, according to recently published work." (epidemiological) [Ep 50 · 11:32](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=692)
- "With ERCP, you're going to get pancreatitis 10% of the time no matter how good you are." (epidemiological) [Ep 50 · 12:02](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=722)
- "With a surgery-first mindset, stone clearance rate reflected by negative intraoperative cholangiogram was 86%." (host_summary) [Ep 50 · 12:14](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=734)
- "If you just did flushing or got the catheter a little more into the common bile duct or reamed the sphincter, the success rate was in the 90s." (epidemiological) [Ep 50 · 12:25](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=745)
- "MMP-7 was identified about 10 years ago by Georgia Bezarra as a diagnostic biomarker for biliary atresia." (host_summary) [Ep 50 · 13:07](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=787)
- "Data from a recent Midwest study shows that every 10-day delay in biliary atresia treatment worsens outcomes by 20%." (host_summary) [Ep 50 · 13:41](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=821)
- "MMP-7 is not a validated biomarker for biliary atresia; it's not perfect, and the sensitivity is pretty good, but cutoffs vary because the assay is still evolving." (host_summary) [Ep 50 · 13:58](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=838)
- "The institutional commitment is to perform Kasai procedure within 7 days of patients showing up if they have biliary atresia." (host_summary) [Ep 50 · 14:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=855)
- "REBOA can be used in children if you have it at your center and you're good at it, though it's not done a lot in pediatric hospitals." (host_summary) [Ep 50 · 15:08](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=908)
- "REBOA seems to take longer than opening the abdomen or chest if you're just needing to cross-clamp the aorta." (host_summary) [Ep 50 · 15:48](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=948)
- "Patients presenting with wounds as their initial presentation for pilonidal disease tend to not always get to the finish line fully healed with a minimally invasive approach." (host_summary) [Ep 50 · 16:23](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=983)
- "John Armstrong, while serving in the US Army, ran a clinic where patients were shaved weekly, and they observed a dramatic improvement, significantly reducing the need for surgical intervention in pilonidal disease." (host_summary) [Ep 50 · 16:40](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=1000)
- "If you're not pushing hair removal and meticulous hygiene, you're probably going to end up operating on some people that might not need an operation for pilonidal disease." (host_summary) [Ep 50 · 16:55](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=1015)
- "For pilonidal disease hair removal, if there's a parent or active caregiver involved, clipping is probably the easiest and simplest approach, with once-a-week recommended." (host_summary) [Ep 50 · 17:17](https://qa.library.globalcastmd.com/watch/update-course-rewind-2024-top-ten-key-takeaways-10526?t=1037)
- "Cryoanalgesia temporarily blocks nerve conduction along peripheral nerve pathways by freezing the affected nerve" — Lizzie Lee (host_summary) [Ep 51 · 1:02](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=62)
- "The freeze causes axonal degeneration while the epineurium stays intact" — Timothy Lotz (clinical) [Ep 51 · 1:19](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=79)
- "When fibrous outer neural structures remain intact, axons can regenerate in 4 to 6 weeks" — Lizzie Lee (host_summary) [Ep 51 · 1:25](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=85)
- "Epidurals are invasive procedures that take time and may or may not be left in fully" — Timothy Lotz (opinion) [Ep 51 · 1:51](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=111)
- "Epidurals usually only give pain relief for a few days" — Lizzie Lee (host_summary) [Ep 51 · 1:57](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=117)
- "Cryoanalgesia can help with pain control all through the recovery period" — Lizzie Lee (host_summary) [Ep 51 · 1:57](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=117)
- "Dr. Lotz's group has performed 300 thoracotomy cases with cryoanalgesia and seen great results" — Timothy Lotz (clinical) [Ep 51 · 2:10](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=130)
- "For thoracotomies, cryoprobe should be applied 1 to 2 levels above and below the thoracotomy" — Timothy Lotz (clinical) [Ep 51 · 2:17](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=137)
- "At T10 level or lower, cryoanalgesia can cause pseudohernias on the abdominal wall from affecting motor branches" — Lizzie Lee (host_summary) [Ep 51 · 2:23](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=143)
- "60 seconds of cryoprobe application is sufficient" — Timothy Lotz (clinical) [Ep 51 · 2:32](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=152)
- "Temporary intercostal nerve blocks are used to help for the first 8 hours before cryoanalgesia sets in" — Timothy Lotz (clinical) [Ep 51 · 2:33](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=153)
- "Standard cryoprobe can be used down to age 3" — Timothy Lotz (clinical) [Ep 51 · 2:39](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=159)
- "Dr. Lotz's group has performed cryoanalgesia in children down to about 18 months" — Timothy Lotz (clinical) [Ep 51 · 2:42](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=162)
- "A cardiac probe used for ablations can be used in smaller children" — Lizzie Lee (host_summary) [Ep 51 · 2:44](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=164)
- "In smaller children, a retractor must hold skin away because limited chest wall musculature could result in skin freeze" — Timothy Lotz (clinical) [Ep 51 · 2:52](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=172)
- "The newest probe has shaft insulation that only reaches room temperature, eliminating skin freeze risk as only the probe tip gets cold" — Lizzie Lee (host_summary) [Ep 51 · 2:58](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=178)
- "With cryoanalgesia, patients do not need epidural or Foley catheter and can get up and move right away" — Timothy Lotz (clinical) [Ep 51 · 3:09](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=189)
- "Pulmonary toilet has been great with cryoanalgesia" — Timothy Lotz (opinion) [Ep 51 · 3:13](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=193)
- "Dr. Lotz's group saw a 2 to 3-fold reduction in narcotic use during hospitalization with cryoanalgesia" — Timothy Lotz (clinical) [Ep 51 · 3:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=195)
- "Patients were able to be discharged home without any narcotic prescriptions" — Lizzie Lee (host_summary) [Ep 51 · 3:21](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=201)
- "With cryoanalgesia, surgeons do not have to wait for a regional anesthesia team" — Lizzie Lee (host_summary) [Ep 51 · 3:24](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=204)
- "In Dr. Lotz's study, 23 thoracotomies received cryoanalgesia" — Timothy Lotz (clinical) [Ep 51 · 3:37](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=217)
- "The intercostal nerve cryoablation group used 137 oral morphine equivalents during hospital stay compared to 533 in the regional nerve block group" — Lizzie Lee (host_summary) [Ep 51 · 3:40](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=220)
- "Dr. Lotz's group now uses cryoanalgesia for all thoracotomies except neonatal cases" — Timothy Lotz (clinical) [Ep 51 · 3:50](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=230)
- "Cryoablation is not limited to thoracotomy or thoracoscopy; there are novel ways to use cryotherapy in a percutaneous approach." — Lizzie Lee (host_summary) [Ep 52 · 0:56](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=56)
- "Interventional radiology has percutaneous needle options available for cryotherapy beyond the standard cryoprobe." (clinical) [Ep 52 · 1:04](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=64)
- "Cryoablation has shown real benefits for rib fractures, slipping rib syndrome, and other endochondromas." — Thomas Inge (clinical) [Ep 52 · 1:12](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=72)
- "Slipping rib syndrome is a condition with cartilaginous union at the end of the ribs, particularly for floating ribs but also for false ribs." — Lizzie Lee (host_summary) [Ep 52 · 1:21](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=81)
- "Laxity in costochondral junctions and impingement on intercostal nerves as the ribs slip and float causes slipping rib syndrome." — Thomas Inge (clinical) [Ep 52 · 1:28](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=88)
- "Slipping rib syndrome can be the cause of chronic abdominal wall pain." — Thomas Inge (clinical) [Ep 52 · 1:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=90)
- "Patients with slipping rib syndrome may have already had their appendix or gallbladder removed before arriving at the correct diagnosis." — Thomas Inge (clinical) [Ep 52 · 1:44](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=104)
- "Patients with slipping rib syndrome often undergo multiple colonoscopies, CTs, and ultrasounds before diagnosis." — Thomas Inge (clinical) [Ep 52 · 1:51](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=111)
- "Slipping rib syndrome is more common in teenage girls than boys." — Lizzie Lee (host_summary) [Ep 52 · 1:58](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=118)
- "Patients with slipping rib syndrome often present with somatic tenderness of the abdominal wall that can be elicited by asking them to flex or crunch their abdominal muscles, but they really won't have a visceral type tenderness." — Lizzie Lee (host_summary) [Ep 52 · 2:01](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=121)
- "The usual approach for patients with slipping rib syndrome is to refer them to chronic pain for evaluation and intercostal block with steroid and long-acting local anesthetic." — Thomas Inge (clinical) [Ep 52 · 2:12](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=132)
- "If patients get pain relief from the intercostal block with ropivacaine and dexamethasone, the next step is to refer them to interventional radiology for ultrasound-guided cryotherapy." — Lizzie Lee (host_summary) [Ep 52 · 2:25](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=145)
- "If there's a response to intercostal block, the next step is to refer to surgery." — Thomas Inge (clinical) [Ep 52 · 2:34](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=154)
- "Interventional radiology performs cryoablation using needle probes at single or multiple levels for slipping rib syndrome." — Thomas Inge (clinical) [Ep 52 · 2:38](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=158)
- "Cryoablation can be used intraoperatively in combination with surgery to remove rib tips or stabilize a slipping cartilaginous costal margin." — Thomas Inge (clinical) [Ep 52 · 3:01](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=181)
- "Outcomes from using cryoablation for slipping rib syndrome included reduced pain scores, reduced narcotic use, and shorter length of stay in the hospital." — Lizzie Lee (host_summary) [Ep 52 · 3:13](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=193)
- "Patients treated with cryoablation for slipping rib syndrome were able to resume normal activities much earlier." — Lizzie Lee (host_summary) [Ep 52 · 3:19](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=199)
- "For patients with chest rib fractures who get stuck on a ventilator, cryoablation can do a world of good by anesthetizing the intercostal spaces that are the problem." — Thomas Inge (clinical) [Ep 52 · 3:27](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=207)
- "Interventional radiology colleagues use the same needles for cryoablating liver lesions and lung nodules that can be applied to intercostal nerve cryoablation." (clinical) [Ep 52 · 3:55](https://qa.library.globalcastmd.com/watch/update-course-rewind-part-2-non-pectus-uses-of-cryoanalgesia-2024-10622?t=235)
- "The Donnati et al. study was an observational prospective study in Italy from 2013 to 2022 on 468 patients around 15 years old." — Lizzie Lee (host_summary) [Ep 53 · 1:03](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=63)
- "Surgeons placed 733 pectus bars total across the 468 patients in the Donnati study." — Lizzie Lee (host_summary) [Ep 53 · 1:13](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=73)
- "Bar dislocation is defined as when a pectus bar rotates more than 30 degrees out of place." — Lizzie Lee (host_summary) [Ep 53 · 1:21](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=81)
- "Bridge fixation was significantly more stable than single bar fixation for pectus repair." — Lizzie Lee (host_summary) [Ep 53 · 1:28](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=88)
- "None of the patients with bridge fixation had dislocated bars compared to those who underwent the single bar technique." — Lizzie Lee (host_summary) [Ep 53 · 1:33](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=93)
- "Bridge fixation is the best technique for preventing bar dislocation in pectus excavatum patients." — Lizzie Lee (host_summary) [Ep 53 · 1:39](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=99)
- "University of Split researchers developed a machine learning model to accurately identify appendicitis cases while minimizing unnecessary surgery." — Carlos Colunga (host_summary) [Ep 53 · 2:14](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=134)
- "The machine learning model was trained using data from 551 pediatric patients who underwent appendectomy, using their clinical, laboratory, and anthropometric information." — Carlos Colunga (host_summary) [Ep 53 · 2:24](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=144)
- "The best performing machine learning model achieved 99.7% sensitivity in identifying appendicitis cases." — Carlos Colunga (host_summary) [Ep 53 · 2:37](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=157)
- "The machine learning model has specificity that could potentially help reduce up to 17% of negative appendectomies in high risk patients." — Carlos Colunga (host_summary) [Ep 53 · 2:37](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=157)
- "The machine learning model can differentiate between complicated and uncomplicated appendicitis with a high degree of accuracy." — Carlos Colunga (host_summary) [Ep 53 · 2:54](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=174)
- "The machine learning model uses readily available clinical and lab data without using any advanced imaging." — Carlos Colunga (host_summary) [Ep 53 · 2:54](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=174)
- "The Rao et al. study is a multi-center retrospective study done in the US from 2018 to 2022." — Cecilia Gigena (host_summary) [Ep 53 · 3:34](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=214)
- "The Rao study compared patients with suspected choledocholithiasis who underwent transcystic laparoscopic common bile duct exploration versus those who underwent ERCP first." — Cecilia Gigena (host_summary) [Ep 53 · 3:34](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=214)
- "The Rao study included 252 patients total: 156 in the transcystic laparoscopic common bile duct exploration group and 96 in the ERCP-first group." — Cecilia Gigena (host_summary) [Ep 53 · 3:53](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=233)
- "Patients who underwent transcystic laparoscopic common bile duct exploration had significantly less complication rates compared to ERCP-first patients." — Cecilia Gigena (host_summary) [Ep 53 · 4:02](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=242)
- "Patients who underwent transcystic laparoscopic common bile duct exploration had lower length of stay compared to ERCP-first patients." — Cecilia Gigena (host_summary) [Ep 53 · 4:02](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=242)
- "Attempting a transcystic laparoscopic common bile duct exploration may benefit pediatric choledocholithiasis patients." — Cecilia Gigena (host_summary) [Ep 53 · 4:16](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-24-11235?t=256)
- "Dr. St. Peter's hospital completed a randomized trial of 110 patients comparing epidural and PCA, and epidurals did not show superior results" — Todd Ponsky (host_summary) [Ep 54 · 1:02](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=62)
- "After implementing cryoanalgesia, the first patient went home on post-operative day one, leading Dr. St. Peter to discontinue enrollment in the epidural/PCA comparison trial" — Cecilia Gigena (host_summary) [Ep 54 · 1:21](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=81)
- "Cryoanalgesia uses cold temperatures to cause a conduction block that interrupts pain impulses to the brain" — Todd Ponsky (host_summary) [Ep 54 · 1:56](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=116)
- "The cryoanalgesia technique involves freezing ribs 4 through 7 for two minutes per rib" — Todd Ponsky (host_summary) [Ep 54 · 2:09](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=129)
- "Cryoanalgesia should not be performed on rib 8 or below because it can cause abdominal wall paralysis" — Todd Ponsky (host_summary) [Ep 54 · 2:09](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=129)
- "With cryoanalgesia, length of stay decreased from four days (baseline) to one day" — Cecilia Gigena (host_summary) [Ep 54 · 2:33](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=153)
- "Cryoanalgesia dramatically reduced median morphine equivalents compared to previous pain control methods" — Todd Ponsky (host_summary) [Ep 54 · 2:43](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=163)
- "Dr. Garcia expressed concern that there are no long-term studies of cryoanalgesia and potential for chronic neuropathic pain" — Cecilia Gigena (host_summary) [Ep 54 · 2:52](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=172)
- "Medical devices and implants are not required to undergo clinical trials before introduction to market, unlike medications which require FDA clinical trials with long-term results" — Todd Ponsky (host_summary) [Ep 54 · 3:14](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=194)
- "Dr. Garcia's hospital uses erector spinae catheters placed by the pain team with ultrasound guidance, positioned juxtaposed to but not in the vertebral space" — Cecilia Gigena (host_summary) [Ep 54 · 3:50](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=230)
- "With erector spinae catheters, hospital stay is two days, catheters remain in place for five days total (three days at home on automated pump), and families remove catheters at home on day five" — Cecilia Gigena (host_summary) [Ep 54 · 4:08](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=248)
- "Erector spinae catheters reduced opioid requirements both in hospital and outside the hospital, achieving two-day length of stay compared to four or five days with epidurals" — Todd Ponsky (host_summary) [Ep 54 · 4:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=270)
- "Dr. Rothenberg initially had concerns about cryoanalgesia including added operative time and risk of neuralgia, but after four cases observed that patients not only went home earlier but felt significantly better at discharge" — Cecilia Gigena (host_summary) [Ep 54 · 4:52](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=292)
- "Multimodal pain control components include Tylenol, NSAIDs, precedex for gentle wake-up, dexamethasone for post-anesthetic nausea, ketamine to avoid opioids, and support from child life specialists, mindfulness resources, and physical therapists" — Todd Ponsky (host_summary) [Ep 54 · 5:34](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=334)
- "Dr. Ponsky's multimodal regimen includes preoperative counseling, gabapentin pre and postoperatively, methadone, clonidine, bowel regimen medications, and antiemetics" — Cecilia Gigena (host_summary) [Ep 54 · 5:34](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=334)
- "At Nebraska where Dr. Rayner practices, length of stay is under two days and patients are off opioids by one week using multimodal pain control" — Cecilia Gigena (host_summary) [Ep 54 · 6:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=375)
- "Bar flippage typically occurs early and is caused by the bar sitting in an incorrect intercostal space, poor positioning, inadequate wrapping, or insufficient securing" — Todd Ponsky (host_summary) [Ep 54 · 6:26](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=386)
- "Bar flippage is a surgical technique issue; the bar must sit in a comfortable position before securing or it will not remain stable" — Todd Ponsky (host_summary) [Ep 54 · 6:26](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=386)
- "Computational modeling by physics-minded surgeons showed that shorter flat bars create more pressure on the sternum compared to traditional U-shaped bars, potentially increasing stability" — Cecilia Gigena (host_summary) [Ep 54 · 7:35](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=455)
- "Bar length selection is not standardized, though there is a trend toward shorter bars based on computational stress modeling" — Todd Ponsky (host_summary) [Ep 54 · 7:49](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=469)
- "Dr. Wolkine uses sternal elevator in about 10% of cases, primarily in younger patients where thoracoscopy provides adequate visualization" — Todd Ponsky (host_summary) [Ep 54 · 8:01](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=481)
- "Sternal elevation in deep, stiff pectus cases allows less tissue damage and better repair" — Todd Ponsky (host_summary) [Ep 54 · 8:01](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=481)
- "Dr. St. Peter uses sternal elevator in every case because it eliminates guesswork and facilitates entering and exiting at the same intercostal space" — Todd Ponsky (host_summary) [Ep 54 · 8:01](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=481)
- "Techniques to avoid cardiac injury during introducer passage include thoracoscopy, sternal elevator, vacuum bell in the operating room, and sub-xiphoid incision" — Cecilia Gigena (host_summary) [Ep 54 · 8:58](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=538)
- "Some surgeons pass the bar from left chest to right chest because passing right to left directs the introducer toward the ventricle" — Todd Ponsky (host_summary) [Ep 54 · 9:20](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=560)
- "Bar passage direction (left-to-right versus right-to-left) is surgeon preference; as long as the sub-sternal space is well dissected and visualization is clear, direction likely does not make a significant difference" — Todd Ponsky (host_summary) [Ep 54 · 9:20](https://qa.library.globalcastmd.com/watch/update-course-rewind-pectus-excavatum-2021-13668?t=560)

## Common questions
### What did Cecilia Gigena say about Pectus Excavatum?
Cecilia Gigena discussed pain management and surgical approaches for pectus conditions. For pectus excavatum repair, she highlighted that cryoanalgesia helps with both pain management and hospital cost reduction. She presented research comparing epidural and erector spinae catheters for pain control, and a randomized trial showing epidurals did not provide superior pain relief. She advocated for multimodal pain control combining medications, regional techniques, and supportive therapies. She also addressed sternal elevation in deep cases to minimize tissue damage, and distinguished pectus arcuatum from pectus carinatum as separate conditions requiring different surgical approaches.

## Changelog
- Sep 9: Summaries and takeaways published for 4 audiences
- Sep 7: Audit reverted — short clips unhidden
- Sep 7: 1 item hidden — never mention Pectus Excavatum; unhide from the owner view
- Aug 31: 64 doctors auto-found from episode dossiers
- Aug 30: 53 doctors auto-found from episode dossiers
- Aug 30: 49 doctors auto-found from episode dossiers
- Aug 30: Members-only episodes removed from this collection
- Aug 29: 58 doctors auto-found from episode dossiers
- Aug 29: 62 doctors auto-found from episode dossiers
- Aug 29: Collection generated from campaign corpus: 68 items, 53 dossiers, summaries for 3 audience(s)
- Aug 29: Collection reviewed and published
- Aug 29: Collection generated from campaign corpus: 58 items, 53 dossiers, summaries for 1 audience(s)
- Aug 29: Collection generated from campaign corpus: 58 items, 53 dossiers, summaries for 3 audience(s)

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