John DiFiore
22 statements · 1 topic · summaries given as host listed separately
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I've gotten multiple calls from other surgeons that say, sometimes my 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 that anterior axillary line.
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Pectus Excavatum
That's particularly important for people who are not using a double lumen tube where they're crossing the mediastinum and have the lung as an issue.
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Pectus Excavatum
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John's statements about Pectus Excavatum 22 statements
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Update Course Rewind: Cryoanalgesia in Pectus Cases 2024
Quotation
I'm going to go through our technique at the clinic. We use a double lumen tube in all patients.
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Statement
Doctor De Fiori performs cryoanalgesia from T3 to T8, although most of the literature is just to T7.
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Quotation
You can see the exposure that we get from the double lumin endotracheal tube, which is exceptional. It's very quick and easy to do, and it, and you know that you're getting it right, right on the nerve.
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Quotation
A lot of people hesitate because of the time involved, so I'm gonna talk just very briefly about that for people who are already using cryo.
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Statement
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.
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Quotation
The tip now gets down to temperature about 20 seconds faster. The freeze cycle is 90 seconds instead of 2 minutes. It's 15 seconds less to thaw back to the temperature.
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Quotation
That's particularly important for people who are not using a double lumen tube where they're crossing the mediastinum and have the lung as an issue.
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Statement
A new 10 millimeter probe with a 60-second freeze cycle that gets down quicker is coming out on October 1st.
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Quotation
I use it in all cases. The exposure of the intercostal nerves is exceptional, and it ensures that you're applying it posterior enough, so you get the lateral cutaneous branch, and I'm gonna show you a diagram.
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Statement
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.
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Quotation
I've gotten multiple calls from other surgeons that say, sometimes my 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 that anterior axillary line.
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Statement
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.
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Statement
If you don't get posterior enough with the cryoprobe, that's when you get blocks that are ineffective.
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Quotation
If you don't get posterior enough, that's when you get blocks that are ineffective. So, a double lumen tube greatly facilitates that.
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Statement
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.
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Quotation
The peak pain scores have dropped from about 5 to about 3. It hasn't affected our length of stay because 98% of our patients go home the next day anyway.
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Statement
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.
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Quotation
Again, this is a new thing, but it's very easy to do. The probe takes half the amount of time, and now I'm doing double the number of blocks.
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Statement
The new probe takes half the amount of time, and Doctor De Fiori is now doing double the number of blocks.
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Summaries John gave as host · 2 summaries
Recaps of other experts' statements, not John's own clinical position.
Summaries John gave as host · Pectus Excavatum 2 summaries
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Update Course Rewind: Cryoanalgesia in Pectus Cases 2024
Host summary
John DiFiore summarizing a resource: 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.
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Host summary
John DiFiore summarizing a resource: 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.
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